cancer of cervix


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cancer of cervix, staging, management and nursing management

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cancer of cervix

  1. 1. Cervical Cancer PRESENTED BY TAGE YAJA M.Sc NURSING 1st YEAR
  2. 2. Definition • Cervical cancer is caused by a virus called HUMAN PAPILLOMA VIRUS. • It is the malignant neoplasm of the cervix. The tumor may developed from the surface epithelium of the cervix or from the epithelial lining of the cervical canal.
  3. 3. incidence • New Cases 130,000/year • Died from CC 20,000~30,000/year
  4. 4. Risk Factor • • • • • infection by HPV virus early sexual activity cigarette smoking oral contraceptives irregular screening history
  5. 5. Risk factor (cont)…. • • • • • nutritional deficiency ( folate, carotene, vit c) obesity poor immune system (HIV) age (30-39 & 60 -69) diethylstilbestrol
  6. 6. The Cervix Cervix and nearby organs
  7. 7. Pathophysiology
  8. 8. Normal pre invasive cancer invasive cancer
  9. 9. Cancer Cells Growths on the cervix can be benign or malignant. Benign growths are not cancer. They are not as harmful as malignant growths (cancer). Benign growths (polyps, cysts, or genital warts): • are rarely a threat to life • don’t invade the tissues around them Malignant growths (cervical cancer): • may sometimes be a threat to life • can invade nearby tissues and organs • can spread to other parts of the body
  10. 10. How does cervical cancer spread? Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues. The cancer cells can spread by breaking away from the original (primary) tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis.
  11. 11. Patterns of spread • Direct invasion cervical stroma, vagina, and parametrium. • Lymphatic spread pelvic and then par aortic lymph nodes • Hematogenous spread such as lungs, liver, and bone
  12. 12. Symptoms Abnormal vaginal bleeding —Bleeding that occurs between regular menstrual periods —Bleeding after sexual intercourse, douching, or a pelvic exam —Menstrual periods that last longer and are heavier than before —Bleeding after going through menopause. - Increased vaginal discharge -Pelvic pain -Pain during sex - Foul smelling discharge
  13. 13. Diagnostic evaluation
  14. 14. PAP smear collection.
  15. 15. • Cytologic test • PAP smear (Papanicolaou) • Blood test • Colposcopic test • Cervical biopsy and Endocervical Curettage • Imaging studies • CT Scan • MRI • X ray
  16. 16. Cervical Cancer Staging • Stage I: The carcinoma is confined strictly to the cervix • Stage II: The tumor extends to the upper part of the vagina. It may extend beyond the cervix into nearby tissues toward the pelvic wall with depth between 5-7mm. The tumor does not invade the lower third of the vagina or the pelvic wall. • Stage III: The tumor extends to the lower part of the vagina. It may also have invaded the pelvic wall. If the tumor blocks the flow of urine, one or both kidneys may not be working well. • Stage IV: The tumor extend beyond the true pelvic or has involved the mucosa of the bladder or rectum or spread to other parts of the body. • Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.
  17. 17. Treatment Women with cervical cancer have many treatment options. The options are Surgery Radiation Therapy Chemotherapy or a combination of methods. The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment choice may also depend on whether the woman wishes to become pregnant someday. Cancer treatments often damage healthy cells and tissues, so side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
  18. 18. Surgical management
  19. 19. Is an option for women with Stage I or II cervical cancer. The surgeon removes tissue that may contain cancer cells:  Radical Trachelectomy: Removal of the cervix, part of the vagina, and the lymph nodes in the pelvis. Recommended for a small number of women with small tumors who wants to try to get pregnant later on.  Total Hysterectomy: Removal of the cervix and uterus.  Radical Hysterectomy: Removal of the cervix, some tissue around the cervix, the uterus, and part of the vagina.  Fallopian Tubes and Ovaries: The surgeon may remove both fallopian tubes and ovaries. This surgery is called a salpingo-oophorectomy.  Lymph Nodes: The surgeon may remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.
  20. 20. Radiation therapy
  21. 21. Radiation Therapy  External Radiation Therapy: A large machine directs radiation at your pelvis or other tissues where the cancer has spread. The treatment usually is given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each treatment takes only a few minutes.  Internal Radiation Therapy: A thin tube is placed inside the vagina. A radioactive substance is loaded into the tube. You may need to stay in the hospital while the radioactive source is in place (up to 3 days). Or the treatment session may last a few minutes, and you can go home afterward. Once the radioactive substance is removed, no radioactivity is left in your body. Internal radiation may be repeated two or more times over several weeks.
  22. 22. Chemotherapy For the treatment of cervical cancer, chemotherapy is usually combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy alone may be used. • Chemotherapy uses drugs to kill cancer cells. • The drugs for cervical cancer are usually given through a vein (intravenous). • You may receive chemotherapy in a clinic, at the doctor’s office, or at home. • Some women need to stay in the hospital during treatment.
  23. 23. Side effects of chemotherapy
  24. 24. Other management • Cryosurgery is the destruction of abnormal tissue using sub-zero temperatures. ( normal liver are frozen to 190°C for 15 minutes) • Cryosurgery is a new technique that can destroy tumors in a variety of sites (brain, breast, kidney, prostate, liver). • Palliative treatment helps to improve people’s quality of life by reducing symptoms of cancer without trying to cure the disease. It is particularly important for people with secondary cancer. However, it is not just for end-of-life care and it can be used at different stages of cancer.
  25. 25. complications Disease related • Low blood counts • Uteric pain due to pyelitis and pyelonephritis • Vesicovaginal fistula • Menorrhagia • Post-menopausal PV bleed Related to surgery • • • • Infection & sepsis Hemorrhage Severe pain Shock
  26. 26. Complications (cont..) Related to radiation • Anorexia • Fatigue. • Nausea . • Vomiting • Skin changes, which range from redness (like a sunburn) to • blistering and peeling where the radiation enters the body • Low blood counts Related to chemotherapy • Immune suppression • Myeolosupression • mucositis • Nausea • Vomiting • Diarrhea • Alopecia • Loss of appetite • Increased chance of infection • Easy bruising or bleeding • Fatigue
  27. 27. Nursing management Pre-operative • • • • • Assess patient’s condition. Give careful attention to post opt. bleeding. Providing close monitoring &care for first 2-3 days. Early ambulation. Close monitoring the patient undergoing cryosurgery for hemorrhage & hypothermia. • Instruct the patient to follow up visit
  28. 28. Post operative • • • • • Assess patient’s condition. Give careful attention to post opt. bleeding. Providing close monitoring &care for first 2-3 days. Early ambulation. Close monitoring the patient undergoing cryosurgery for hemorrhage & hypothermia. • Instruct the patient to follow up visit
  29. 29. Nursing diagnosis • Pain related to cancer & treatment effect as evidenced by pain scale & facial expression. • Imbalanced nutrition less than body requirement related to anorexia, vomiting as evidenced by weight loss. • Impaired tissue integrity related to treatment as evidenced by mucocitis. • Anxiety related to diagnosis of cancer as evidenced by talking with family member. • Risk for infection related to immune suppression. • Impaired urinary elimination R/T surgical incision.
  30. 30. prognosis Depends on clinical stage • Pathologocal type Adenocarcinoma and adenosquamous carcinoma have a somewhat lower 5-year survival rate than squamous carcinoma, stage for stage •
  31. 31. The end