Cervical Cancer

Is a common gynecologic malignancy. Most commonly occurs in women age 35 to 55. Major risk factors include early sexual activity, multiple sexual partners, and history of sexually transmitted diseases especially human papilloma virus and herpes simplex virus. Cervical cancer may involve the bladder, rectum, and may metastasize to the lungs, mediastinum, bones, and liver. Types of cervical cancer includes: o Dysplasia atypical cells with some degree of surface maturation. o Carcinoma in Situ (CIS) which is confined to the cervical epithelium. o Invasive carcinomas the stroma is involved, 90% are of the squamous cell type. o Invasive cancer spreads by local invasion and lymphatics to the vagina and beyond.

Assessment 1. Early disease is usually asymptomatic. 2. Initial symptoms are postcoital bleeding, irregular vaginal bleeding or spotting between periods or after menopause, and malodorous discharge. 3. As disease progresses, bleeding becomes more constant and is accompanied by pain that radiates to buttocks and legs. 4. Weight loss, anemia, and fever signal advance disease. Diagnostic Evaluation 1. Papanicolaou (Pap) smear for cervical cytology is usual screening test. A computerized screening program may increase the accuracy of manual laboratory Pap screening by as much as 30%. 2. If Pap test is abnormal, colposcopy, and biopsy or conization may be done. 3. Additional testing includes metastatic workup (chest x-ray, I.V. urogram, cystoscopy, barium studies of colon and rectum, sigmoidoscopy) Therapeutic Interventions 1. Intracavitary radiation for earlier localized stages radium by way of applicator in endocervical canal. 2. External radiation for generalized pelvis effect in later stages. 3. Laser therapy may be used to treat dysplasia. 4. Chemotherapy may be used as adjuvant to surgery or radiation treatments.

Surgical Interventions 1. Conization is performed for microinvasize stage if child-bearing is desired. 2. Cryosurgery, laser ablation, and loop electrosurgical excision procedure may be done for dysplasia or CIS. 3. Hysterectomy, simple or radical depending on stage. 4. Pelvic exenteration for very advanced disease if radiation therapy cannot be used; also for recurrent cancer. Nursing Interventions 1. During intracavitary radiation, check radioisotope applicator position every 8 hours, and monitor amount of bleeding and drainage (a small amount is normal). 2. Observe for signs and symptoms of radiation sickness such as nausea, vomiting, fever, diarrhea, abdominal cramping. 3. Monitor for complications of surgery bleeding, infection. 4. Help the patient seek information on stage of cancer, treatment options. 5. Provide emotional support during treatment. 6. Advise patient to discharge after surgical procedures and need to report excessive, foulsmelling, discharge or bleeding. 7. Explain the importance of life-long follow up regardless of treatments to determine the response to treatment and to detect spread of cancer. 8. Encourage all women to receive regular cervical cancer screening. The HPV Vaccine The human papilloma virus (HPV) vaccine prevents infection with certain serotypes of human papilloma virus associated with the development of cervical cancer, genital warts, and some less common cancers. The HPV vaccine is recommended for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series. Note: The vaccine is not recommended for pregnant women.