S.

NO

CONTRIBUTORY
OBJECTIVES

Teacher will be able

to establish rapport
with the group

TIME

1mi
n

To differentiate
between Tumor and
cyst

A.V.
AIDS
USED

EVALUATION

Verball
y

Self-introduction - My name is Puneet Kaur , student of M.Sc

Nursing 1st year. I will discuss about Tumors and cyst of ovaries and
fallopian tubes.

What do you know about Tumor and Cyst?

2
min

Verball
y

Introduction

At the end of the

teaching the group
will be able to :
3

TEACHING AND LEARNING ACTIVITIES

METHOD OF
TEACHING

The group will be

able to :
Recall previous
knowledge

SUBJECT MATTER

2mi
n

Tumor: An abnormal benign or malignant new growth of tissue that

possesses no physiological function and arises from uncontrolled
usually rapid cellular proliferation-called also neoplasm.
Cysts: Cysts are abnormal, closed sac-like structures within a tissue
that contain a liquid, gaseous, or semisolid substance. Cysts can
occur anywhere in the body and can vary in size. The outer, or
capsular, portion of a cyst is termed the cyst

Lecture

Cum
Discussion

Verball
y

What is the
differnce
between
tumor and
cyst?

S.NO

4.

CONTRIBUTORY
OBJECTIVES

Students will be able to

define cancer and types
of fallopian tube

TIM
E

2
min

SUBJECT MATTER

TEACHING AND LEARNING ACTIVITIES

METHOD OF
TEACHING

TUMORS OF THE FALLOPIAN TUBES

Malignancies of the fallopian tube are rare and are the least
common type of genital cancer. These are of two types- Primary
and secondary

Lecture

A.V.
AIDS
USED

LCD

Cum
Discussion

EVALUATION

What are the

types of
tumors of
fallopian
type?

Primary Carcinoma of the fallopian tube is very rare. The

incidence of tubal carcinoma is less than 0.5 % of gynaecological
malignancies.

Eneumerate the clinical

features and diagnostic
test of tumor of fallopian
tube

Secondary Carcinoma is more common than the primary The

common primary sites are ovary uterus, breast and gastrointestinal tract.The mode of spread from the ovary or uterus is
probably by lymphatics rather than a direct one
2mi
n

CLINICAL FEATURES
Patient Profile-The patients are usually postmenopausal and
nulliparous
Symptoms
-Postmenopausal bleeding
-Intermittent profuse watery discharge
-Colicky pain lower abdomen
Signs

Lecture cum
discussion

Verball
y

What are the

clinical
features and
diagnostic
test of tumor
of fallopian
tube?

Bimanual examination reveals an unilateral mass which may be

tender. If reduced in size on compression, along with a watery
discharge through the cervix, it is very much suspicious.
DIAGNOSIS
Most often accidentally discovered on laprotomy and histologic
examination of the excised tube
Suspected features are:
Persistent postmenopausal bleeding with uterine pathology being
excluded by curettage
Persistent positive PAP smear with a negative cervical and
endometrial pathology
Laparoscopy-In cases of persistent post menopausal bleeding with
a negative uterine pathology
6.

To Enlist various
treatment modalities of
tumors of fallopian tube

TREATMENT
6mn

The treatment for fallopian tube cancer will take into account the
patient's stage of disease, medical history, current health and
personal preference, among other things. The goal of treatment of
fallopian tube cancer is to eradicate the cancer completely with
minimal side effects.
SURGERY
Surgery for fallopian tube cancer is determined by the stage of the
cancer from previous imaging tests. A procedure called asalpingooophorectomy is used in the treatment of early-stage fallopian

tube cancer. A salpingo-oophorectomy is the surgical removal of

the either one or both of the fallopian tubes, and either one or both
of the ovaries.

In more advanced stages the surgical procedures will include: total

abdominal hysterectomy (removal of uterus), bilateral salpingooophorectomy, infracolic omenectomy (removal of abdominal
lining), appendectomy (removal of appendix), peritoneal
washings, and peritoneal biopsies.
Radiation Therapy
Radiation therapy refers to use of high energy x-rays to kill cancer
cells. Radiation is not considered a primary treatment for fallopian
tube cancer because of its low efficacy and side effects. However,
it may be used prior to surgery to help shrink a tumor in size to
make surgery more manageable. It may also be used in cases
where chemotherapy is refused or contraindicated.
Chemotherapy
Chemotherapy is the use of anti-cancer medications that go
throughout the entire body. Chemotherapy is rarely used as the
only treatment for fallopian tube cancer, but rather given after
surgery to kill any remaining cancer cells. Platinum based
chemotherapies (carboplatin and cisplatin) are most commonly
used in the treatment of fallopian tube cancer. The two most

commonly used medications are carboplatin and paclitaxel.

effects. In some cases, chemotherapy will be given directly into
the abdomen (called intraperitoneal chemotherapy). Your provider
will decide on a regimen that will best treat your cancer and your
specific needs.

S.NO

CONTRIBUTORY
OBJECTIVES

Students will be able to

describe ovarian cancer

TIM
E

2mi
n

SUBJECT MATTER

TEACHING AND LEARNING ACTIVITIES

METHOD OF
TEACHING

Lecture

Description
1. Ovarian cancer grows rapidly, spreads fast, and is often
Cum
bilateral.
2. Metastasis occurs by direct spread to the organs in the pelvis, by Discussion
distal spread through lymphatic drainage, or by peritoneal seeding.
3. In its early stages, ovarian cancer is often asymptomatic
because most women are diagnosed in advanced stages, ovarian
cancer has more deaths than any other cancer of the female
reproductive system, particularly white women between 55 and 65
years of age of North American or European descent.

A.V.
AIDS
USED

LCD

EVALUATION

What is
ovarian
cancer?

4. An exploratory laparotomy is performed to diagnose and stage

the tumor.

Enlist the types of ovarian

tumors

5mi
n

Ovarian Enlargement
Non -neoplstic
Neoplastic
Non-Neoplastic-The non-neoplastic enlargement of the ovary is
usually due to accumulation of fluid inside the functional unit of
the ovary.Cysts are usually soft,are surrounded by a thin capsule
and may be detected during the reproductive years.
The causes are:
Follicular cyst
Corpus luteum cyst
Theca lutein and granulosa lutein cysts
Polycystic ovarian syndrome
Endometrial cyst

Types of ovarian cancer (Neoplstic)

Epithelial carcinoma. Epithelial carcinoma makes up

85% to 90% of ovarian cancers.

The main histologic types of epithelial tumors include

serous, endometrioid, clear cell, mucinous, mixed tumors,
and several rare malignancies, including Brenner and

transitional cell cancers.

Germ cell malignancies. This uncommon type of

ovarian cancer develops in the egg-producing cells of
the ovaries. Germ cell malignancies typically occur in
females aged 10 to 29 years.

The types of germ cell tumors are dysgerminomas,

immature teratoma, and endodermal sinus tumors (called
EST and yolk sac tumors), which include embryonal
carcinoma.

S.NO

CONTRIBUTORY
OBJECTIVES

Students will be able to

identify the risk factors
and clinical manifestation
of ovarian tumors

Stromal malignancies. This rare form of ovarian

cancer develops in the connective tissue cells that hold
the ovaries together. This tissue sometimes makes the
female hormones estrogen and progesterone. Over 90%
of these stromal tumors are granulosa cell tumors,
either adult or childhood types.

TIM
E

2m

SUBJECT MATTER

TEACHING AND LEARNING ACTIVITIES

METHOD OF
TEACHING

A.V.
AIDS
USED

EVALUATION

Risk Factors
Risk factors also include nulliparity and infertility.
Older age is a major risk factor because the incidence of this
disease peaks in the eighth decade of life.
High dietary fat intake, mumps before menarche, use of talc in the
perineal area, and family history are suspected to increase risk,

Lecture
Cum
Discussion

LCD

What are the

risk factors
and clinical
manifestatio
ns of ovarian

tumos?

while multiparity, oral contraceptive use, breastfeeding, and

anovulatory disorders may be protective.
Clinical Manifestations
Symptoms are nonspecific and include increased abdominal girth,
pelvic pressure, bloating, indigestion, flatulence, increased waist
size, leg pain, and pelvic pain.
5m

10
To enlist the diagnostic
test used in ovarian
tumors

Diagnostic Test
The following tests and procedures may be used:

Physical exam and history : An exam of the body to

check general signs of health, including checking for signs of
disease, such as lumps or anything else that seems unusual. A
history of the patients health habits and past illnesses and
treatments will also be taken.
Pelvic exam : An exam of the vagina, cervix,
uterus, fallopian tubes, ovaries, and rectum. A speculum is
inserted into the vagina and the doctor or nurse looks at the
vagina and cervix for signs of disease. A Pap test of the cervix
is usually done.
Ultrasound exam: A procedure in which high-energy
sound waves (ultrasound) are bounced off internal tissues or
organs in the abdomen, and make echoes. The echoes form a
picture of body tissues called a sonogram.
CA 125 assay : A test that measures the level of CA 125 in
the blood. CA 125 is a substance released by cells into the
bloodstream. An increased CA 125 level can be a sign of
cancer or another condition such as endometriosis.

Lecture cum
discussion

LCD

What are the

different
tests used in
diagnosis of
ovarian
tumor?

S.NO

CONTRIBUTORY
OBJECTIVES

TIM
E

CT scan (CAT scan): A procedure that makes a series of

detailed pictures of areas inside the body, taken from different
angles. The pictures are made by a computer linked to an xray machine.
PET scan (positron emission tomography scan): A
procedure to find malignant tumor cells in the body. A very
small amount of radioactive glucose (sugar) is injected into a
vein. The PET scanner rotates around the body and makes a
picture of where glucose is being used in the body.
MRI (magnetic resonance imaging): A procedure that
uses a magnet, radio waves, and a computer to make a series
of detailed pictures of areas inside the body. This procedure is
also called nuclear magnetic resonance imaging (NMRI).
Chest x-ray : An x-ray of the organs and bones inside the
chest. An x-ray is a type of energy beam that can go through
the body and onto film, making a picture of areas inside the
body.
Biopsy : The removal of cells or tissues so they can be
viewed under a microscope by a pathologist to check for signs
of cancer. The tissue is usually removed during surgery to
remove the tumor.

SUBJECT MATTER

TEACHING AND LEARNING ACTIVITIES

METHOD OF
TEACHING

A.V.
AIDS
USED

EVALUATION

Medical Management
11

Students will be able to

describe the medical
management of ovarian
tumor

5mn

SURGICAL MANAGEMENT
Surgical staging, exploration, and reduction of tumor mass are the Lecture
basics of treatment. Surgical removal is the treatment of choice. A
Cum
total abdominal hysterectomy with removal of the fallopian tubes
and ovaries and the omentum (bilateral salpingooophorectomy and
Discussion
omentectomy) is the standard procedure for early disease.

Verball
y

Explain the
medical and
surgical
management
of ovarian
tumor?

PHARMACOLOGIC THERAPY
Chemotherapy often follows surgery, usually with
cyclophosphamide(Cytoxan), doxorubicin (Adriamycin), cisplatin
(Platinol-AQ), carboplatin (Paraplatin), or paclitaxel
(Taxol).Hexamethylmelamine (Hexalen), ifosfamide (Ifex), bone
marrow transplantation, and peripheral blood stem cell support
may alsobe used.
Liposomal therapy, delivery of chemotherapy in a
liposome,allows the highest possible dose of chemotherapy to the
tumor target with a reduction in adverse effects.
Radiation may be helpful and is more useful in some types of
ovarian cancer than others

S.NO

CONTRIBUTORY
OBJECTIVES

TIM
E

SUBJECT MATTER

TEACHING AND LEARNING ACTIVITIES

METHOD OF
TEACHING

A.V.
AIDS
USED

Nursing Assessment
Students will be able to

10m

Malignant tumors of the female reproductive system can be found

Verball

EVALUATION

12

explain the nursing

management of ovarian
tumor

in the cervix, endometrium ovaries, vagina,and vulva. A patient

with any of these malignant tumors may experience a variety of
clinical manifestations, including leukorrhea, irregular vaginal
bleeding, vaginal discharge, abdominal pain and pressure, bowel
and bladder dysfunction and vulvar itching and burning
Assessment for these signs and symptoms is an important nursing
responsibility
Nursing Diagnosis
Nursing diagnoses for the female patient with cancer of the
reproductive system include
Anxiety related to threat of a malignancy and lack of knowledge
about the disease process and prognosis.
Acute pain related to pressure secondary to an enlarging tumor
Disturbed body image related to loss of body parts and loss of
good health
Ineffective sexuality pattern related to physiologic limitation and
fatigue
Grieving related to poor prognosis of advanced disease
Planning
The overall goals are that the patient with cancer of the female
reproductive system will
Actively participate in treatment decisions
Achieve satisfactory pain and symptom management
Recognise and report problems promptly
Maintain preferred lifestyle as long as possible
Continue to practice detection strategies
Nursing Implementation

Lecture
Cum
Discussion

Describe the
nursing
management
of ovarian
tumor?

Health Promotion
Teach women the importance of routine screening for cancers of
reproductive system. When cancer is identified early, treatment
can be more conservative and woman's prognosis improves.
A yearly pelvic examination and Pap test allow the health care
provider to detect lesions on the vulva or any uterine or ovarian
irregularities and screen for cervical cancer.
Teaching women about risk factors for cancer of the reproductive
system is also important. Limiting sexual activity during
adolescence, using condoms, having fewer sexual partners, not
smoking reduce the risk of cervical cancer. When high risk
behaviours are identified, assist women in modifying their life
styles to decrease risk.
Acute Intervention Related to Surgery
All patients experience a degree of anxiety when contemplating
surgery, but the prospect of major gynecologic surgery increase
these concerns.
Some women may experience guilt, anger ,or embarrassment .Still
other may focus on the effect the surgery will have on their
reproductive and sexual functions
.Each patient needs to be assessed as an individual .Be willing to
listen, since this can provide considerable psychologic support.
Patients with advanced ovarian cancer may develop ascites and
pleural effusion. Nursing care may include administering
intravenous therapy to alleviate fluid and electrolyte imbalances,
Preoperatively prepare the patient physically for surgery with the

standard perineal or abdominal preparation. A vaginal douche and

enemas may be given. The bladder should be emptied before the
patient is sent to the operating room. An indwelling catheter is
commonly inserted properly
Postoperatively the patient who has had abdominal hysterectomy
will have abdominal hystrectomy will have an abdominal
dressing. Observe the dressing frequently for any sign of bleeding
during the first 8 hours after surgery.
The patient who has had a vaginal hysterectomy will have a
perineal pad .A moderate amount of serosanguineous drainage on
the perineal pad is expected. The patient may experience urinary
retention postoperatively because of temporary bladder atony
resulting from edema and trauma.
Take special care to prevent the development of deep vein
thrombosis .Frequent change of position, avoidance of high
fowler's position and avoidance of pressure under the knees
mimimize stasis and pooling of blood. Pay special attention to
patient with varicosities.
The loss of uterus may bring about grief response to some
women,similar to any great personal loss. The ability to bear
children may be associated with her perception of womanhood.
Elicit the woman's feeling and concerns about her surgery
Teach patient to avoid activities that may increase pelvic
congestion, such as dancing and walking swiftly,for several
months
Acute Intervention With Radiation Therapy
Instruct the patient who is to recieve external radiation to urinate
immediately before the treatment to minimize radiation exposure

to the bladder. Advice her about radiation side effects, including

enteritis and cystitis.
Nursing management of the patient receiving internal radiation
therapy requires special consideration. No individual nurse should
take care of the patient for more than 30 min per day. Instruct
visitors to stay 6 ft away from the bed and limit visiits to less than
3 hr/day
EVALUATION
The expected outcomes are that the patient with cancer of the
female reproductive system will

S.NO

CONTRIBUTORY
OBJECTIVES

Actively participate in treatment decisions

Achieve satisfactory pain and symptom management
Recognize and report problems promptly
Maintain preferred lifestyle as long as possible
Continue to practice cancer detection strategies

TIM
E

SUBJECT MATTER

METHOD OF
TEACHING

Summarization:
13

Students will be able to

recognise the topic

1mi

TEACHING AND LEARNING ACTIVITIES

Today we have discussed about

A.V.
AIDS
USED

EVALUATION

discussed

Defination of tumor and cyst

Types of tumors of fallopian tube,their clinical manifestation and
diagnostic test
Medical management of tumors of fallopian tube
Types of tumors and cyst of ovaries
Risk factors,Clinical manifestation and diagnostic test of ovarian
cancer
Medical and nursing management of ovarian tumors
12.

Restate the topic

1
min

Apply the theory

discussed in the class in
preparing assignment.

Ovarian cancer causes more deaths than any other cancer of the
female reproductive system. About 75% of cases are detected at a
late stage. Despite careful examination,ovarian tumors are often
difficult to detect because they are usually deep in the pelvis. No
early screening mechanism exists at present, although tumor
markers are being explored.
Assignment:

List down the tumors of ovaries and fallopian tube

References
1.Chintamani,Medical surgical nursing,7th ed.Delhi: Elsevier Ltd;

Discussion

Verball
y

2010.p.1352-1356
2.Smeltzer CS,Bare GB,Brunner and Suddarth, Textbook of
Medical Surgical Nursing.10th ed.Philadelphia(PA):Mosby;
2004.p.1435-1437
3.D.C Dutta,Text book of gynaecology ,4th ed2009 p.481-483
4.www.pubmed.com

SUBJECT : Medical Surgical Nursing

TOPIC

: Tumor and cyst of Ovary and Fallopian Tube

GROUP OF STUDENTS: Bsc (Nursing) 3rd Year

NO. OF STUDENTS : 90
NAME OF STUDENT TEACHER : Puneet Kaur
METHOD OF TEACHING

: Lecture cum discussion

TEACHING A.V. AIDS : LCD

DATE OF TEACHING :
TIME OF TEACHING

: 45min

VENUE :
SUPERVISOR: Mrs Manju Dhandapani

PREVIOUS KNOWLEDGE : Students have some knowledge about the term tumor and cyst
CENTRAL OBJECTIVE : At the end of the class students will be able to:

Differentiate between tumor and cyst

Enlist the types of tumors of ovary and fallopian tube
Enumerate clinical manifestation and diagnostic test of tumors of ovary and fallopian tube
Explain medical and nursing management related to tumors of ovary and fallopian tube

NATIONAL INSTITUTE OF NURSING

EDUCATION P.G.I.M.E.R
LESSON PLAN ON TUMOR AND CYST OF OVARY
AND FALLOPIAN TUBES
SUB: Medical Surgical Nursing
SUBMITTED TO
MRS MANJU DHANDAPANI
LECTURER,NINE
YR

SUBMITTED BY
PUNEET KAUR
M.SC NURSING 1ST