Which patient is having very high risk for developing ovarian cancer?

JIPMER Nursing Officer-2017

Obstetrics & Gynaecology

Medium

Appeared in: JIPMER Nursing Officer-2017

Explanation

The correct option identifies a 45-year-old woman who has never been pregnant (nulliparous) as being at the highest risk.
Nulliparity is a significant risk factor for ovarian cancer because it implies a long history of uninterrupted ovulatory cycles.
According to the 'incessant ovulation' theory, repeated rupture and repair of the ovarian surface during ovulation increases the chance of malignant transformation.
This patient's profile, combining age with nulliparity, presents the greatest number of cumulative ovulatory cycles compared to the other options, thereby elevating her risk.

Option A: This patient is on oral contraceptives, which are known to be protective against ovarian cancer.
Option B: This patient had her first child at a relatively young age (22 years). Pregnancy and breastfeeding interrupt ovulation, providing a protective effect against ovarian cancer.
Option D: This patient is multiparous (has had multiple children), which is a strong protective factor against ovarian cancer. Each pregnancy provides a long period of anovulation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Risk factors for ovarian cancer to guide bedside assessment, documentation, and the next nursing action.
Nurses play a crucial role in patient education regarding cancer risk factors. It is important to be able to identify patients at high risk for ovarian cancer to provide appropriate counseling on lifestyle, potential genetic testing (if family history is significant), and awareness of subtle symptoms.
Understanding these risk factors helps in taking a comprehensive health history. A nurse noting a history of nulliparity, late-age first pregnancy, or significant family history of breast/ovarian cancer should recognize the need for heightened awareness and potential referral for genetic counseling.
What if? If the 45-year-old nulliparous woman also had a strong family history of breast and ovarian cancer (e.g., a mother and sister with the diseases), her risk would be dramatically higher, and she would be a prime candidate for genetic counseling and testing for BRCA mutations.

How to Approach the Question

First, identify the core concept of the question, which is identifying risk factors for ovarian cancer.
Analyze each option by evaluating the patient's reproductive history provided (age, pregnancies, contraceptive use).
Recall the 'incessant ovulation' hypothesis: factors that increase the number of lifetime ovulations increase risk, while factors that decrease them are protective.
Categorize each patient's profile: Oral contraceptives (protective), early pregnancy (protective), multiparity (highly protective), and nulliparity (risk factor).
Compare the risk profiles. The nulliparous woman has the most significant risk factor among the choices, making her the patient at the highest risk.

Concept Tested & Keywords

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E6 Gynecology Williams pp. 317-390, 318-391