Cervical cancer – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Cervical cancer
Definition of Cervical Cancer
Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope).
Cervical cancer is almost always caused by human papillomavirus (HPV) infection.
Risk Factors/Causes of Cervical Cancer
1. HPV (human papillomavirus) – a sexually transmitted virus. There are more than 100 different types of HPVs, at least 13 of which can cause cervical cancer.
2. Many sexual partners or becoming sexually active early
3. Smoking-increases the risk of developing many cancers, including cervical cancer.
4. A weakened immune system such as in people with AIDS, or transplant recipients taking immunosuppressive medications.
5. Long-term mental stress women who experience high levels of stress over a sustained period may be less able to fight off HPV.
6. Giving birth at a very young age women who give birth before the age of 17 áre significantly more likely to develop cervical cancer compared with women who have their first baby after the age of 25.
7. Several pregnancies women who have had at least three children in separate pregnancies are more likely to develop cervical-cancer compared to women who have never had children.
8. Contraceptive pill – long-term use of some common contraceptive pills slightly raises a woman’s risk.
9. Other sexually transmitted diseases (STD) – women who become infected with chlamydia, gonorrhea, or syphilis have a higher risk of developing cervical-cancer.
10. Socio-economic status – studies in several countries have revealed that women in deprived areas have significantly higher rates of cervical-cancer.
Clinical Feature of Cervical Cancer:
The most common symptoms of cervical cancer are:
- Bleeding between periods
- Bleeding after sexual intercourse
- Bleeding in post-menopausal women
- Discomfort during sexual intercourse
- Smelly vaginal discharge
- Vaginal discharge tinged with blood
- Pelvic pain
Nursing Management of Cervical Cancer:
Assessment
- Early disease is usually asymptomatic.
- Initial symptoms are postcoital bleeding, irregular vaginal bleeding or spotting between periods or after menopause, and malodorous discharge.
- As disease progresses, bleeding becomes more constant and is accompanied by pain that radiates to buttocks and legs.
- Weight loss, anemia, and fever signal advance disease.
Diagnostic Evaluation
- 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%.
- If Pap test is abnormal, colposcopy, and biopsy or conization may be done.
- Additional testing includes metastatic workup (chest x-ray, I.V. urogram, cystoscopy, barium studies of colon and rectum, sigmoidoscopy)
Therapeutic Interventions
- Intracavitary radiation for earlier localized stages radium by way of applicator in endocervical canal.
- External radiation for generalized pelvis effect in later stages.ilani
- Laser therapy may be used to treat dysplasia.
- Chemotherapy may be used as adjuvant to surgery or radiation treatments.
Surgical Interventions
- Conization is performed for microinvasize stage if child-bearing is desired.
- Cryosurgery, laser ablation, and loop electrosurgical excision procedure may be done for dysplasia or CIS.
- Hysterectomy, simple or radical depending on stage.
- Pelvic exenteration for very advanced disease if radiation therapy cannot be used; also for recurrent cancer.
Nursing Interventions
- During intracavitary radiation, check radioisotope applicator position every 8 hours, and monitor amount of bleeding and drainage (a small amount is normal). mecobal
- Observe for signs and symptoms of radiation sickness such as nausea, vomiting, fever, diarrhea, abdominal cramping.
- Monitor for complications of surgery – bleeding, infection.
- Help the patient seek information on stage of cancer, treatment options.
- Provide emotional support during treatment.
- Advise patient to discharge after surgical procedures and need to report excessive, foul- smelling, discharge or bleeding.
- Explain the importance of life-long follow up regardless of treatments to determine the response to treatment and to detect spread of cancer.
- Encourage all women to receive regular cervical cancer screening.
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