SIGNS and SYMPTOMS

Abnormal vaginal bleeding An unusual discharge from the vagina Pain during intercourse

IN ADVANCED STAGES: Pelvic pain Vaginal leakage of urine or stools from a fistula Anorexia Weight loss Anemia

Classified as either preinvasive / invasive carcinoma

1. Pre-invasive Carcinoma Ranges from minimal cervical dysplasia, the lower third of the epithelium contains abnormal cells, to carcinoma in situ The full thickness of epithelium contains abnormally proliferating cells Curable 75% to 90% of the time with early detection and proper treatment.

2. Invasive Cervical Cancer Cells penetrate the basal membranes and can spread directly to contagious pelvic structures or disseminate to distant sites by lymphatic routes. Usually, invasive carcinomas occurs between ages 30 and 50; rarely, under age 20

Physical Examination
Rectal examination may reveal an external mass or gross blood from tumor erosion. Bimanual pelvic examination findings often reveal pelvic or parametrial metastasis. If the disease involves the liver, hepatomegaly may develop. Leg edema suggests lymphatic or vascular obstruction caused by tumor.

Assessment and Diagnostic Findings

In its very early stages, invasive cervical cancer is found microscopically by Pap smear. In later stages, pelvic examination may reveal a large, reddish growth or a deep, ulcerating lesion. The patient may report spotting or bloody discharge. When the patient has been diagnosed with invasive cervical cancer, clinical staging estimates the extent of the disease so that treatment can be planned more specically and prognosis reasonably predicted. The

Physical assessment/clinical manifestations

The patient who has preinvasive cancer often asymptomatic. The classic symptom of invasive cancer is painless, vaginal bleeding. Ask the patient is she has had or now has bleeding. Ask the woman if she has a watery, blood tinged vaginal discharge that becomes dark and foul smelling

 Leg pain (along the sciatic nerve) or swelling of one leg may be a late symptom may indicate recurrent disease. Flank pain may be a late symptom of hydronephrosis (water inside the kidney)

Ask the patient if she has had other signs of recurrence or metastasis such as: Unexplained weight loss Dysuria (painful urination) Pelvic pain(cause by pressure of the tumor on the bladder or the bowel) Hematuria (blood in the urine) Rectal bleeding Chest pain

Surgical management:
Early stage I management techniques includes: local cervical ablation therapies of electrosurgical excision laser therapy cryosurgery

Small tumors that are only microinvasive are managed with: excisional conization hysterectomy Early stage invasive cancers are managed with: radical surgery and radiation Advanced inoperable cancers are treated with:

For cervical cancer that has spread beyond the cervix, one of these procedures may be used: Radical hysterectomy Exenteration 3 types of exenteration: Anterior exenteration Posterior exenteration Total exenteration

Non surgical management: Radiation therapy is reserved for stage 2 invasive cervical cancer. For cancer that has extended beyond the cervix but not to the pelvic wall, radiation therapy is as effective as a radical hysterectomy

Medical management
Cryotherapy (freezing with nitrous oxide) Laser therapy Loop electrosurgical excision procedure Simple hysterectomy if invasion is less than 3mm. Radical trachelectomy is an alternative to hysterectomy

 Drugs most often used to treat cervical cancer include: Cisplatin Carboplatin Paclitaxel (Taxol), Topotecan Gemcitabine (Gemzar)

 Common side effects of chemotherapy can include: Nausea and vomiting Loss of appetite Loss of hair Mouth sores Fatigue (tiredness)

Because chemotherapy can damage the bloodproducing cells of the bone marrow, the blood cell counts might become low. This can result in:

An increased chance of infection (from a shortage of white blood cells) Bleeding or bruising after minor cuts or injuries (because of a shortage of blood platelets) Shortness of breath (due to low red blood cell counts)

Things to do to prevent pre-cancers

Avoid being exposed to HPV Use of Condoms Don't smoke Get vaccinated

 Related Nursing Diagnosis:

Anxiety related to diagnosis of cancer, fear of pain perceived loss of femininity and disfigurement Disturbed body image related to altered fertility, fears about sexuality, and relationships with partner and family Pain related to surgery and other adjuvant therapy Deficient knowledge of perioperative aspects of hysterectomy and self care

Collaborative problems/ potential complications

Hemorrhage Deep vein thrombosis Bladder dysfunction

Nursing interventions
Relieving anxiety Determine how this experience affects the patient and allow the patient to verbalize feelings and identify strengths Improving body image Assess how patient feels about undergoing a hysterectomy related to the nature of diagnosis, significant others, religious belief, and prognosis Acknowledge patient concenrs about ability to have children, loss of femininity, impact on sexual relations

 Educate patient about sexual relations Exhibit interest, concern and willingness to listen to fears Relieving pain Administer analgesics to relieve pain and promote movement and ambulation Apply heat to abdomen or insert a rectal tube if prescribed for abdominal distention

Promoting home and community based care

Teaching patients self care Instruct pt to resume activities gradually; no sitting for long periods; post operative fatigue should gradually decrease Instruct pt to check surgical incision daily and report redness, purulent drainage or discharge Stress the importance of adequate oral intake and maintaining bowel and urinary tract function Teach that showers are preferable to tub baths to reduce risk for infection and injury getting in and out the tub

Continuing care
Make follow up telephone contact with patient to address concerns and determine progress Remind patient to discuss hormone replacement therapy with primary physician, if ovaries are removed Reinforce information regarding resumption of sexual intercourse