Ovarian Cancer

Set the scene.

Ask if they want someone in the room with them.
Check for privacy, room etc


The tests have shown a diagnosis of cancer of the ovaries.
It typically presents at quite an advanced stage.
Its a difficult cancer to pick up early

I know this is some difficult news to take in. Do you need some time to think
about it?

There are number of things we can do to help you through this difficult time,
including surgery, radiotherapy or chemotherapy.

In terms of the outlook, its hard to put a timeframe to it because it varies from
person to person.

Write it down provide some written information and organise review
appointment.
I don't want to overload you with too much information, do you have any
questions for me right now?



Pap smear

1. Hi Mrs Jones My name is Xiuzhi and Im a final year medical student and Ive
been asked to do a pap smear with you today. Have you had a paper smear
before?
a. I will run through what were going to do, but do you have any
particular questions or concerns about the procedure?
b. Is there anything in particular that you would like checked?
2. Explain procedure: Ill run through whats going to happen
a. First of all, I will get you to remove all your clothing below the waist
and cover yourself with a sheet. I will put a pillow underneath the hips
and get you to put your feet together and let your knees fall to the
side.
b. Then I will be inserting a speculum (?explain speculum) into your
vagina and using a brush to collect some cells from your cervix
which is the neck of the uterus/womb, which Ill put onto a slide and
send to a lab.
c. This may be a bit uncomfortable but it shouldnt be painful, and the
more relaxed you are, the easier it will be. If any time you feel
uncomfortable let me know and if you want to stop, just raise your
hand and Ill stop.
d. Do you understand whats going to happen and are you still happy to
go ahead?
3. Prepare the patient for the examination
a. Offer to use the toilet private area to change gown & sheet mirror
under pillow towel on the bed and check light
b. Label slide
c. Wash hands gloves + put a glove on the light
d. Collect kidney dish, speculum (check if clean, check screw, prevent
clattering) warm water + lube
4. Procedure
a. Confirm patient is ready to proceed with examination
b. Ask them to but pillow/towel under the hips
c. Bring your heels to your bottom and relax your knees/ let your knees
fall to the side
d. Pull back the sheet when youre ready
e. Check temperature of speculum against patients upper thigh
f. External inspection
g. Insert speculum
i. Hold speculum in your dominant hand and part labia with non-
dominant hand
ii. Rest the speculum on the fourchette.
iii. Take a deep breath in and then out insert as she breathes
out.
iv. Angle speculum at 45 degrees to the bed
v. Im just opening the entrance to the vagina open speculum
vi. Locate cervix inspect the cervix offer the mirror!!
vii. Tighten screws
viii. Take sample insert brush firmly rotate through 360
ix. Transfer the sample of cells to the glass slide
x. Spray the slide with fixative immediately before removing the
speculum
h. Remove the speculum
i. Place the thumb on the level to keep the bills steady
ii. With your free hand, undo the top screw
iii. Gently open the bills a little and withdraw slightly until you can
see that you have cleared the cervix
iv. Slowly release allow to close observe until the walls close
over remove once it is fully closed
v. Weve finished you can get changed now
i. Place speculum on a tray for cleaning and place disposables in the
contaminated waste bin
j. Wash hands
k. Fill out the request form and put into the slide box thing
5. Complete the procedure
a. Bimanual if required
6. Discussion with the patient
a. Discuss your findings from what I can see everything looks normal
b. Explain when the results will be available
c. How these will be communicated to the patient
d. Warn about spotting and cramping
e. Thank you for coming in to have your pap smear today.
f. Discuss the pap registry and encourage
g. Encourage the patient to attend for other health checks.