Cervical cancer1
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This document discusses cervical cancer, including its definition, pathophysiology, risk factors, signs and symptoms, examinations, treatments, patient education, nursing diagnoses, and wellness both before and after cancer. Cervical cancer is a malignant growth located on the cervix that progresses from premalignant lesions over 10-12 years. Risk factors include early sexual activity, multiple partners, smoking, poor nutrition, and certain infections. Signs may include bleeding, discharge, pain and abnormal periods. Examinations include Pap smears, colposcopy, LEEP, cryosurgery and laser therapy to diagnose and stage the cancer. Treatment depends on cancer stage, size, patient age and fertility desires, and may include surgery
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Cervical cancer1
- 1. Cervical Cancer Christina Jordan, Sarah Stobel, and Jaclyn Stratman
- 2. Definition of Problem Cervical cancer is a malignant neoplasm (abnormal growth) located on the cervix.
- 3. Pathophysiology Cervical cancer is a progressive disease. Premalignant lesions usually occur 10-12 years before the development of invasive carcinoma.
- 4. Risk Factors Intercourse before 16 years of age, or multiple sex partners Smoking Poor nutrition (suppression of immune system) HIV positive women Co-infections with HPV and Chlamydia trachomatis
- 5. Signs and Symptoms Vaginal bleeding Vaginal discharge Abnormal menses Postmenopausal bleeding Serosanguineous or yellowish discharge
- 6. Signs and Symptoms New or foul odor may be present Sever bleeding can lead to anemia Pelvic or epigastric pain Pelvic or back pain
- 7. Examinations
- 8. Pap Smear Instruments Procedure Results
- 9. Colposcopy Instruments Procedure Results
- 10. Loop Electrosurgical Excision Procedure (LEEP) Instruments Procedure
- 11. Cryosurgery Instruments Procedure Information
- 12. Laser Therapy Instruments Procedure Information
- 13. Treatment Treatment Options Depend on the Following: The stage of the cancer The size of the tumor The patient’s desire to have children The patient’s age.
- 14. Treatment Surgery? Radiation Tomo Therapy HI-ART Chemotherapy Complimentary/Alternative- clinical trials http://youtu.be/4NXcrhtTCMg
- 15. Patient Education Prevention/Early Detection Education Treatments and Associated risks Resources
- 16. Nursing Diagnosis Deficient Knowledge r/t lack of information about preoperative routines, postoperative activities, and expected postoperative changes, fear of procedure Acute pain r/t cervical procedure and cramping
- 17. Wellness Pre Cancer Post Cancer
- 18. References http://www.cancercenter.com/cervical-cancer/cervical- cancer-treatment.cfm http://www.cancercenter.com/cervical- cancer/tomotherapy.cfm http://www.cancer.gov/cancerinfo/pdq/treatment/cervical/pati ent/#Keypoint6 http://www.cancer.gov/cancertopics/pdq/treatment/cervical/P atient/page4 http://youtu.be/4NXcrhtTCMg
Editor's Notes
- Invasive cancer of the cervix accounts for approximately 16% of all gynecological cancers and 2% of all cancers of women in the US
- It moves from normal cervical cancer to dysplasia to invasive cancer.
- Pap SmearColposcopyEndocervical Curettage (ECC)ConizationCryosurgeryLoop Electrosurgical Excision Procedure (LEEP)Laser Therapy
- Instruments:Vaginal specula of various sizes, sterile gloves, water soluble lubricant, materials for pap smear or ThinPrep Pap Test and cultures, good light sourceProcedure: Speculum is inserted into vagina to allow visualization of cervix and vaginal walls. The cervix is then “scraped” for collection of cells and put into a solution. The sample is then sent to the lab for testing.Results: A normal Pap smear means the cells looked normal, a abnormal Pap smear means the cells looked abnormal. The 2001 Bethesda System identifies premalignant squamous cell lesions as: Atypical Squamous Cells (ASC), Low-grade squamous intraepithelial lesion (LSIL), High-grade squamous intraepithelial lesion (HSIL), and Cervical intraepithelial neoplasia (CIN)
- Instruments: : Vaginal speculum, sterile gloves, water-soluble lubricant, magnifying instrument called a colposcope, iodine soultion solution or acetic acid solution, small sharp-edged tool called a curette, tools used for a bioposy, cultures, (Monsel's) liquid or silver nitrate swab Procedure: A speculum is inserted into the vagina so the cervix and vaginal walls are better exposed. Iodine or acetic acid solution are swabbed on the cervix. This makes the abnormal cells stand out. The examiner then looks into the vagina with the colposcope. If abnormal cells are present they are bioposied and sent to the lab for testing. Monsel’s liquid or silver nitrate are used if bleeding occurs. An ECC may also be preformed.Results: Normal: The vinegar or iodine does not show any areas of abnormal tissue. The vagina and cervix look normal. A biopsy sample does not show any abnormal cells. Abnormal: The vinegar or iodine shows areas of abnormal tissue. Sores or other problems, such as genital warts or an infection, are found in or around the vagina or cervix. A biopsy sample shows abnormal cells. This may mean cervical cancer is present or likely to develop
- Instrument: speculum, sterile gloves, acetic acid solution or iodine solution, anesthetic, colposcope, electrically charged wire loop ,(Monsel’s) liquid or silver nitrate swab.Procedure:Speculum inserted into vagina. The vaginal walls and cervix are swabbed with acetic acid or iodine solution. The colpscope is then placed outside the vagina. The loop is used to cut away a thin layer of surface tissue where the abnormal cells are located. Then a swab of Monsel’s liquid or silver nitrate is used to stop the bleeding.
- Instruments: same as colposcopy, nitrous oxide.Procedure: Speculum inserted into vagina. Nitrous oxide applied directly onto cancerous cells. Information: A double freezing method which causes necrosis of the tissue. This procedure should be preformed about a week after a menstrual period.
- Instruments:same as colposcopy, carbon dioxide laser (endoscope).Procedure:Speculum inserted into vagina. The flexible endoscope is then inserted and directed at the lesion which is visible by using the colposcope. The laser is turned on and “boils” the tissue.Information:May take up to 12 weeks to heal.
- The stage of the cancer The size of the tumor The patient’s desire to have children The patient’s age.From http://www.cancer.gov/cancerinfo/pdq/treatment
- Surgery: Conization Total hysterectomy Bilateral Salpingo-oopherectomy Radical hysterectomy Cyro surgery/therapy Loop electrosurgical excision procedure (LEEP) Other: Radiation: high energy x-rays to kill or stop cell growthExternal Radiation- machine outside of body Internal Radiation- radioactive substances sealed in needles, seeds, wires, catheters in or near tumorsTomoTherapy HI-ART http://www.cancercenter.com/cervical-cancer/tomotherapy.cfm-TomoTherapy® combines an advanced form of intensity modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, all in one machine.Chemotherapy: uses drugs to stop growth of tumor by killing or stopping cell division Systemic- orally, intra-arterially Regional- body cavity, organ, spinal columnComplementary/Alternative: Nutritional Therapy Naturopathic MedicineNutrition, Botanic, Oriental, and Physical Medicine Mind-Body Physical Therapy Spiritual Support Image Enhancement
- Prevention/Early Detection Education HPV vaccine ?, identify pt. risk factors Encourage regular pap examsSigns and SymptomsTreatments and Associated risksSide effects-what to expect Complimentary treatments availableResources Support groups Reliable sources of information
- Wellness diagnosispre cancerHealth seeking behaviors r/t client participating in regular pelvic exams, aware of risk factors.Post cancerHealth seeking behaviors r/t pt. active participant in treatment decisionsReadiness for enhanced coping r/t pt. acceptance of cancer, seeks social supportReadiness for enhanced knowledge r/t pt. actively asks questions regarding her cancer and treatment options
- http://www.cancercenter.com/cervical-cancer/cervical-cancer-treatment.cfm http://www.cancercenter.com/cervical-cancer/tomotherapy.cfmhttp://www.cancer.gov/cancerinfo/pdq/treatment/cervical/patient/#Keypoint6http://www.cancer.gov/cancertopics/pdq/treatment/cervical/Patient/page4