Adult Medical-Surgical Nursing Reproductive Health Module: Cervical Cancer
Cervical Cancer: Description Carcinoma of the cervix of the uterus is mainly squamous cell Classification: CIN I and II (Cervical Intra-epithelial Neoplasia): mild to moderate dysplasia CIN III: severe dysplasia (carcinoma in situ). Still pre-invasive Invasive carcinoma
Cervical Cancer: Aetiology Mainly occurs in younger women (child-bearing age) Multiple sex partners and unprotected sex Smoking; malnutrition; drug abuse *Chronic genital infection especially HPV: Human Papilloma Virus (genital wart virus) Other sexually transmitted diseases (STD) as genital herpes, chlamydia, gonorrhoea, HIV
Cervical Cancer: Clinical Manifestations Intermenstrual bleeding per vagina Bleeding after intercourse Watery or foul-smelling vaginal discharge (advanced) Possibly post-menopausal bleeding
Cervical Cancer: Diagnosis/ Screening for Early Detection Papanicolau cervical smear (Pap smear): cells scraped from inside the cervical canal. Yearly screening advised If abnormal Pap smear: Cone biopsy (wide wedge of surrounding tissue excised for examination/ staging) Colposcopy (examination of the uterus) If invasive: further tests to assess extent
Invasive Cervical Cancer: Further Tests to Assess Extent of Disease D&C (Dilatation and Curettage) MRI CT scan IVP Barium studies (bowel) Bone scan
Cervical Cancer: Prevention Health Education: Avoid multiple partners/ unprotected sex Seek optimum health and nutritional status ↓ smoking ↓ drug and alcohol abuse Annual screening through Pap Smear Vaccination for HPV now being used as public health measure
Cervical Cancer: Management CIN I and II (pre-invasive): Cryotherapy (nitrous oxide freezing) or laser to remove Regular follow-up with Pap smear CIN III (also pre-invasive): Cone biopsy, colposcopy, laser or cryotherapy Careful regular follow-up Post-childbearing, hysterectomy an option
Invasive Cervical Cancer: Management Further tests to assess extent of disease Staging (TNM): Tumour, Nodes, Metastases Radical surgery: Total Hysterectomy and Bilateral Salpingo-oophrectomy Radiation therapy: external beam and brachytherapy (internal pack) Chemotherapy
Cervical Cancer: Nursing Considerations Clear health education related to: Lifestyle measures Regular Pap smear Vaccination for HPV Emotional and psychological support to patient and family involved in treatment