CONFIRMING DIAGNOSIS Unexplained postmenopausal bleeding and an abnormal Papanicolaou smear (suspicious or positive in up to 50% of all cases) suggest fallopian tube cancer, but laparotomy is usually necessary to confirm this diagnosis.
When fallopian tube cancer involves both the ovary and fallopian tube, the primary site is difficult to identify. The preoperative workup includes:
❑ultrasound or plain film of the abdomen to help delineate tumor mass
❑ excretory urography to assess renal function and show urinary tract anomalies and ureteral obstruction
❑ chest X-ray to rule out metastasis
❑ barium enema to rule out intestinal obstruction
❑ computed tomography of the abdomen and pelvis
❑ routine blood studies
❑electrocardiogram.
Treatment
Treatment of fallopian tube cancer consists of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy; chemotherapy with progestogens, cyclophosphamide, and cisplatin; and external radiation for 5 to 6 weeks. All patients should receive some form of adjunctive therapy (radiation or chemotherapy), even when surgery has removed all evidence of the disease.
Special considerations
Good preoperative patient preparation and postoperative care, patient instruction, psychologic support, and symptomatic measures to relieve radiation and chemotherapy adverse effects can promote a successful recovery and minimize complications.
For example, reinforce the physician's explanation of the diagnostic and treatment procedures. Explain the need for preoperative studies, and tell the patient what to expect: fasting from the evening before surgery, an enema to clear the bowel, insertion of an indwelling urinary catheter attached to a drainage bag, placement of an I.V. line and, possibly, sedative medication. Describe the tubes and dressings the patient can expect to have in place when she returns from surgery. Teach the patient deep-breathing and coughing techniques to prepare her for postoperative exercises.
After surgery:
❑Check vital signs every 4 hours. Report fever, tachycardia, and hypotension to the physician.
❑Monitor I.V. fluids.
❑Change dressings regularly, and check for excessive drainage and bleeding and signs of infection.
❑Provide antiembolism stockings as ordered.
❑Encourage regular deep breathing and coughing.
❑If necessary, institute incentive spirometry.
❑Turn the patient often, and help her reposition herself, using pillows for support.
❑Auscultate for bowel sounds. When the patient's bowel function returns, ask the dietitian to provide a clear liquid diet; then, when tolerated, a regular diet.
❑Encourage the patient to walk within 24 hours after surgery. Reassure her that she won't harm herself or cause wound dehiscence by sitting up or walking.
❑Provide psychological support. Encourage the patient to express anxieties and fears. If she seems worried about the effect of surgery on her sexual activity, reassure her that this surgery will not inhibit sexual intimacy.
❑Before radiation therapy begins, explain that the area to be irradiated will be marked with ink to precisely locate the treatment field. Explain that radiation may cause a skin reaction, bladder irritation, myelosuppression, and other systemic reactions.
❑During and after treatment, watch for and treat adverse effects of radiation and chemotherapy.
❑Before discharge, to minimize adverse effects during outpatient radiation and chemotherapy, advise the patient to maintain a high-carbohydrate, high-protein, low-fat, low-bulk diet to maintain caloric intake but reduce bulk. Suggest that she eat several small meals per day instead of three large ones.
❑Include the patient's husband or other close relatives in patient care and teaching as much as possible.
Stress the importance of a regular pelvic examination to patients, and tell them to contact a physician promptly about any gynecologic symptom.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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