Question

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 dx 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 examination of the patient's vagina, uterus, rectum and pelvis, including ovaries, and checked for masses or growths. He followed the pelvic dx 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.
Based on this information, what signs and symptoms have you identified in A. J.’s history that may manifest her present condition?

Answer 1

what additional questions will you ask A. J

Bowel and bladder fuctions

Changes in wieght

use of hormone replacement therapy

What will be your priority assessment?

As the patient's mother is a cancer survivor,and her symptoms are pointing to suspect ovarian cancer but further diagnosis is needed.

What is the significance of the CA-125 assay?

CA -125 assay meaures the amount of protien CA -125 in blood which is found most common in ovarian cancer.

How will this affect A. J.’s plan of care?

When the test result is high, she should be evaluated with other diagnostic test for ovarian cancer and treatment,either surgical or medical treament to be started as early as possible.