PerioMedCare

Chemotherapy for Ovarian Cancer – Taxotere and Carboplatin

Introduction

You have been prescribed a chemotherapy regimen that includes Taxotere (docetaxel) and Carboplatin to treat ovarian cancer. This handout provides information on how these medications work, what to expect during treatment, and how to manage potential side effects.

What Are Taxotere and Carboplatin?

Taxotere (Docetaxel): Taxotere is a chemotherapy drug that belongs to a class of medications called taxanes. It works by disrupting the microtubule structures within cancer cells, which are essential for cell division. This disruption leads to the death of the cancer cells.

Carboplatin: Carboplatin is a platinum-based chemotherapy drug that damages the DNA of cancer cells, preventing them from growing and dividing. It is often used in combination with other chemotherapy drugs, like Taxotere, to enhance its effectiveness.

How Is the Treatment Administered?

Administration: Both Taxotere and Carboplatin are given through an intravenous (IV) infusion, typically in an outpatient clinic. The infusion process can take several hours.

Treatment Cycle: Chemotherapy is usually given in cycles. A cycle may last for 3 weeks, and the number of cycles you will receive depends on your specific treatment plan, which your oncologist will discuss with you.

What to Expect During Treatment

Common Side Effects:

• Fatigue: Feeling tired is common, especially in the days following treatment.
• Nausea and Vomiting: These are common side effects, but they can often be managed with medications prescribed by your doctor.
• Hair Loss: Taxotere can cause hair loss, which usually starts a few weeks after the first treatment.
• Low Blood Cell Counts: Both drugs can lower your white blood cells, red blood cells, and platelets, making you more prone to infections, anemia, and bleeding or bruising easily.

Less Common Side Effects:

• Peripheral Neuropathy: Tingling, numbness, or pain in your hands and feet.
• Allergic Reactions: Some patients may experience an allergic reaction during the infusion, which will be monitored by your healthcare team.

Managing Side Effects

• Stay Hydrated: Drink plenty of fluids to help flush the medications through your system.
• Medication for Side Effects: Your doctor may prescribe medications to help manage nausea, vomiting, and other side effects. Be sure to take them as directed.
• Balanced Diet: Eating a balanced diet can help you maintain your strength and energy levels. Small, frequent meals may be easier to tolerate.
• Rest and Activity: Listen to your body. Rest when you need to, but also try to stay active to keep your energy up.

When to Call Your Doctor

• Fever or Signs of Infection: If you experience a fever (temperature of 100.4°F or higher) or signs of an infection (like a sore throat, cough, or burning during urination), contact your healthcare provider immediately.
• Severe Side Effects: If you experience severe side effects like difficulty breathing, swelling, or a rash, seek medical attention right away.
• Support and Resources
• Emotional Support: Coping with cancer treatment can be challenging. Don’t hesitate to reach out to your healthcare team, support groups, or a counselor for emotional support.
• Practical Support: Consider asking family or friends for help with daily tasks during your treatment. Your healthcare team can also connect you with resources for transportation, financial assistance, and more.

Conclusion

Taxotere and Carboplatin are important components of your treatment plan for ovarian cancer. While chemotherapy can be challenging, your healthcare team is here to support you every step of the way. If you have any questions or concerns about your treatment, don’t hesitate to ask your oncologist or nurse.

Radical Wide Local Excision

Radical wide local excision is a surgical procedure typically used to treat certain types of cancer, including skin cancers like melanoma or soft tissue sarcomas. The goal of this surgery is to remove the tumor along with a margin of healthy tissue surrounding it to ensure complete excision and reduce the risk of recurrence.

Key Points about Radical Wide Local Excision:

1. Indications:
   • Often used for skin cancers (e.g., melanoma, squamous cell carcinoma, VIN, basal cell carcinoma).
   • May also be used for soft tissue sarcomas or other localized tumors.
2. Procedure:
   • The surgeon removes the lesion with a margin of healthy tissue around it. The size of the margin depends on the type and size of the tumor.
   • The procedure aims to achieve clear margins, meaning no cancer cells are found at the edges of the removed tissue.
   • Lymph nodes may also be evaluated or removed if there’s a concern for metastasis.
3. Postoperative Considerations:
   • The excised tissue is typically sent for histopathological analysis to confirm clear margins.
   • Depending on the location and extent of the excision, reconstruction of the surgical site might be necessary using grafts or flaps.
   • Follow-up care includes monitoring for recurrence and managing any functional or cosmetic consequences of the surgery.
4. Risks and Complications:
   • Like all surgeries, radical wide local excision carries risks of infection, bleeding, and scarring.
   • There may be a need for additional treatments such as radiation or chemotherapy, depending on the pathology results and tumor staging.
5. Patient Care:
   • Postoperative care includes wound management, pain control, and monitoring for any signs of infection or complications.
   • Patients may require support with rehabilitation or adjustments if the excision significantly affects mobility or function, particularly in cases involving extremities.

Patient Handout: Radical Hysterectomy with Bilateral Salpingo-Oophorectomy (BSO), Pelvic Lymph Node Dissection (PLND), and Para-Aortic Lymph Node Dissection (PALND)

Introduction

You are scheduled for a radical hysterectomy with bilateral salpingo-oophorectomy (BSO), pelvic lymph node dissection (PLND), and para-aortic lymph node dissection (PALND). This surgery involves the removal of the uterus, cervix, both ovaries, fallopian tubes, and specific lymph nodes in the pelvic and para-aortic regions. This procedure is often performed to treat gynecologic cancers in particular cervical cancer.

Preoperative Instructions

Bowel Preparation:

• Medications: Take Dulcolax as instructed by your surgeon to clear your bowels before surgery.
  • Timing: You will be instructed to take Dulcolax the evening before your surgery. Please follow the dosage instructions provided by your healthcare team.

Fasting Instructions:

• Nothing by Mouth: Do not eat or drink anything after midnight on the night before your surgery. This includes water, gum, and mints.

Pre-Surgery Hygiene Instructions

• On the morning of your surgery, please bathe with Hibiscrub to reduce the risk of infection.

Hospital Check-In:

• Arrival Time: Please arrive at the hospital by 7:00 AM on the day of your surgery.
• Location: Proceed to the registration area at the hospital to check in.

Registration and Financial Clearance:

• Day Before Surgery: You will need to complete your registration and financial clearance at Doctors Hospital the day before your surgery. Please ensure all paperwork and payments are handled to avoid any delays.

Anesthesia Consultation:

• You will need to see the anesthesia team prior to your surgery to discuss your anesthesia plan, including any concerns you may have and your medical history.

What to Bring to the Hospital

• Nightclothes (comfortable and easy to wear)
• Toiletries (toothbrush, toothpaste, hairbrush, etc.)
• Slippers or Comfortable Shoes
• Personal Identification and any required Insurance Information
• Reading Material or anything else to help you stay comfortable during your hospital stay

Possible Complications

While the surgery is intended to improve your health, it’s important to be aware of potential risks and complications, including:

• Injury to Bladder or Bowel: Due to the nature of the surgery, there is a risk of injury to your bladder or bowel. This may require additional procedures to repair.
• Injury to Blood Vessels: Surgery may result in blood vessel injury, which could require blood transfusions.
• Infection: As with any surgery, there is a risk of infection. This may be managed with antibiotics.
• Bleeding: Blood loss during surgery may necessitate the need for a blood transfusion. We recommend arranging for blood donors in advance.
• Blood Clots: Post-operative blood clots in the legs or lungs are a potential risk. Your healthcare team will provide measures to reduce this risk.

Important Reminders

• Blood Donation: It is advisable to arrange for blood donors ahead of time, as you may require a transfusion during or after the surgery.
• Follow-Up Care: Post-operative care and follow-up appointments will be crucial for your recovery. Your healthcare team will provide detailed instructions.

Ovarian Cancer Surgery and Staging 

Overview
Ovarian cancer surgery is a critical part of treatment for ovarian cancer. It involves the removal of the tumor and may include surrounding tissues or organs. The surgery also helps in staging the cancer, which determines the extent of its spread.

Types of Surgery
1. Total Hysterectomy: Removal of the uterus.
2. Bilateral Salpingo-Oophorectomy: Removal of both ovaries and fallopian tubes.
3. Unilateral Salpingo-Oophorectomy: Removal of one ovary and one fallopian tube (often used in fertility-sparing surgery).
4. Omentectomy: Removal of the omentum, a layer of fatty tissue.
5. Lymph Node Biopsy/Dissection: Removal of lymph nodes to check for cancer spread.

Fertility-Sparing Surgery
For younger patients wishing to preserve fertility, fertility-sparing surgery may be an option. This involves:
– Removing only the affected ovary and fallopian tube.
– Preserving the uterus and the other ovary.
Fertility-sparing staging includes thorough examination and possible removal of pelvic and para-aortic lymph nodes, omentum, and peritoneal biopsies to ensure accurate staging.

Staging
Staging is the process of determining the extent of cancer spread. It is done during surgery and includes:
1. Stage I: Cancer is confined to the ovaries.
2. Stage II: Cancer has spread to pelvic organs.
3. Stage III: Cancer has spread to the abdominal cavity.
4. Stage IV: Cancer has spread to distant organs.
Accurate staging helps in planning further treatment, such as chemotherapy or radiation.

Risks and Complications

As with any major surgery, ovarian cancer surgery comes with risks and potential complications, including:
– Infection: Risk of infection at the incision site or internally.
– Bleeding: There may be excessive bleeding during or after the surgery.
– Blood Clots: Increased risk of blood clots forming in the legs (deep vein thrombosis) or lungs (pulmonary embolism).
– Damage to Nearby Organs: Possible injury to organs such as the bladder, intestines, or blood vessels.
– Adhesions: Scar tissue can form, leading to bowel obstruction or chronic pain.
– Anesthesia Risks: Reactions to anesthesia can occur, though rare.

Recovery and Follow-Up
Recovery time can vary, but typically includes:
– Hospital Stay: A stay of several days to monitor for immediate post-surgical complications.
– Pain Management: Use of pain medications to manage post-operative pain.
– Activity Restrictions: Limited physical activity for several weeks, avoiding heavy lifting and strenuous exercise.
– Follow-Up Visits: Regular follow-up appointments to monitor recovery and check for cancer recurrence.

Emotional and Psychological Support
It’s normal to experience a range of emotions following a cancer diagnosis and surgery. Support options include:
– Counseling: Professional support from a counselor or psychologist.
– Support Groups: Joining a support group for ovarian cancer patients.
– Family and Friends: Leaning on loved ones for emotional support.

Conclusion
Ovarian cancer surgery is a crucial step in treating and managing ovarian cancer. Understanding the process, including the types of surgery, staging, risks, and recovery, can help you prepare and make informed decisions about your care. Always discuss any concerns or questions with your healthcare team to ensure you receive the best possible care.
If you have any questions or need further information, please do not hesitate to contact your healthcare provider.

Patient Handout: Diet Advice for Managing High Cholesterol

What is Cholesterol?

Cholesterol is a type of fat found in your blood. Your body needs some cholesterol to function properly, but too much can lead to health problems, such as heart disease and stroke.

Understanding Your Cholesterol Levels

There are two main types of cholesterol:

• LDL (Low-Density Lipoprotein): Often called “bad” cholesterol because high levels can lead to plaque buildup in your arteries and result in heart disease.
• HDL (High-Density Lipoprotein): Known as “good” cholesterol because it helps remove LDL cholesterol from your arteries.

A healthy balance between these two types is essential for heart health.

Dietary Tips to Lower Cholesterol

1. Reduce Saturated Fats:
   • Found in red meat, full-fat dairy products, and processed foods.
   • Aim to consume lean meats, skinless poultry, and low-fat or fat-free dairy options.
2. Eliminate Trans Fats:
   • Common in fried foods and baked goods like cookies, cakes, and pastries.
   • Check food labels for partially hydrogenated oils, which are a major source of trans fats.
3. Increase Omega-3 Fatty Acids:
   • These fats do not affect LDL cholesterol but have other heart benefits, including reducing blood pressure.
   • Good sources include salmon, mackerel, walnuts, and flaxseeds.
4. Eat More Soluble Fiber:
   • Soluble fiber can reduce the absorption of cholesterol into your bloodstream.
   • Include foods such as oatmeal, kidney beans, Brussels sprouts, apples, and pears in your diet.
5. Add Whey Protein:
   • Found in dairy products, whey protein can lower both LDL cholesterol and total cholesterol.
   • Consider incorporating low-fat dairy products like yogurt or whey protein supplements into your meals.
6. Increase Intake of Fruits and Vegetables:
   • High in fiber and antioxidants, which can help lower LDL cholesterol.
   • Aim for at least 5 servings of fruits and vegetables daily.
7. Choose Healthy Fats:
   • Use olive oil, canola oil, or avocado oil instead of butter or margarine.
   • Include nuts, seeds, and avocados in your diet for healthy fats.
8. Limit Salt Intake:
   • Excessive salt can raise your blood pressure, contributing to heart disease.
   • Aim to consume no more than 2,300 milligrams of sodium per day (about one teaspoon of salt).
9. Stay Hydrated:
   • Drinking plenty of water can help maintain a healthy weight and improve your overall health.
   • Aim for at least 8 glasses of water a day.

Lifestyle Changes for Better Cholesterol Management

• Exercise Regularly: Engage in at least 30 minutes of moderate exercise, such as walking, jogging, or cycling, most days of the week.
• Quit Smoking: Smoking lowers your HDL cholesterol. Quitting can improve your HDL level and overall heart health.
• Maintain a Healthy Weight: Losing weight, even just 5-10% of your body weight, can help lower your cholesterol levels.
• Limit Alcohol Consumption: Excessive alcohol can lead to high cholesterol and triglycerides. Stick to no more than one drink per day for women and two for men.

Regular Monitoring

It’s important to have your cholesterol levels checked regularly. Follow your healthcare provider’s advice and schedule regular check-ups to monitor your progress.

Need More Help?

If you have questions about your cholesterol levels or need personalized advice, please contact your healthcare provider or a registered dietitian. They can help you develop a plan that fits your lifestyle and health needs.

Patient Handout: Understanding Acid Reflux

What is Acid Reflux?

Acid reflux, also known as gastroesophageal reflux (GER), occurs when stomach acid flows back into the esophagus, the tube that connects your mouth to your stomach. This can cause a burning sensation in your chest, often referred to as heartburn.

Symptoms of Acid Reflux

Common symptoms of acid reflux include:

• Heartburn: A burning sensation in the chest, usually after eating, which might be worse at night or when lying down.
• Regurgitation: A sour or bitter-tasting acid backing up into your throat or mouth.
• Bloating: Feeling full quickly or feeling bloated after eating.
• Dysphagia: A sensation of food being stuck in the esophagus.
• Chronic Cough: A persistent cough not related to respiratory conditions.
• Hoarseness or Sore Throat: Irritation caused by stomach acid affecting the throat.

Causes of Acid Reflux

Acid reflux can be caused by various factors, including:

• Dietary Habits: Consuming large meals, spicy foods, fatty foods, chocolate, caffeine, alcohol, or acidic foods like citrus and tomatoes.
• Lifestyle Factors: Smoking, obesity, and lying down soon after eating.
• Medical Conditions: Hiatal hernia, pregnancy, or certain medications that relax the lower esophageal sphincter (LES).

Managing Acid Reflux

Lifestyle Changes

1. Diet:
   • Avoid trigger foods and beverages that may cause heartburn.
   • Eat smaller, more frequent meals rather than large meals.
   • Avoid eating 2-3 hours before bedtime.
2. Weight Management:
   • If overweight, losing weight can reduce pressure on the stomach, preventing acid reflux.
3. Avoid Smoking and Alcohol:
   • Both can weaken the LES, leading to acid reflux.
4. Elevate the Head of Your Bed:
   • Raising the head of the bed by 6-8 inches can prevent acid from flowing back into the esophagus while sleeping.

Medications

Several over-the-counter and prescription medications can help manage acid reflux:

• Antacids: Provide quick relief by neutralizing stomach acid (e.g., Tums, Rolaids).
• H2 Blockers: Reduce the amount of acid the stomach produces (e.g., ranitidine, famotidine).
• Proton Pump Inhibitors (PPIs): Block acid production and heal the esophagus (e.g., omeprazole, esomeprazole).

When to See a Doctor

If you experience frequent acid reflux or if lifestyle changes and medications do not relieve your symptoms, it’s important to consult with your healthcare provider. You should seek medical attention if you have:

• Difficulty swallowing or painful swallowing.
• Persistent nausea or vomiting.
• Unexplained weight loss.
• Chest pain, especially if it’s combined with arm pain, shortness of breath, or jaw pain.

Complications of Untreated Acid Reflux

If left untreated, acid reflux can lead to more serious conditions, including:

• Esophagitis: Inflammation of the esophagus.
• Esophageal Stricture: Narrowing of the esophagus due to scar tissue.
• Barrett’s Esophagus: A condition where the esophageal lining changes, increasing the risk of esophageal cancer.

Conclusion

Acid reflux is a common condition that can often be managed with lifestyle changes and medications. However, it’s important to monitor symptoms and consult with a healthcare provider if you experience frequent or severe symptoms.

If you have any questions or concerns about managing acid reflux, please contact your healthcare provider.