MDC3 week1

REFERENCES

1. American Cancer Society. (2020, July 30). What is cervical cancer? https://www.cancer.org/cancer/cervical - cancer/about/what -is- cervical- cancer.html 2. March, P. P., & Holle, M. R. (2017). Cervical cancer: an overview. CINAHL Nursing Guide. https://search.ebscohost.com/login.aspx?direct=true& AuthType=ip,shib&db=nup&AN=T703247&site=eds- live&custid=s9076023 3. Workman, L. M. (2018). Medical-Surgical Nursing (9th ed.). Elsevier. https://ambassadored.vitalsource.com/ books/9780323461580

CERVICAL CANCER

SIGNS AND SYMPTOMS

• Often asymptomatic (3)

• Painless vaginal bleeding is common - spotting between periods, after sex or douching (3)

• Unexplained weight loss, painful urination, pelvic pain, bloody urine, rectal bleeding, chest pain

• Physical exams may not detect abnormalities in the early stage (3)

MULTIDIMENSIONAL CARE

A cervical cancer treatment team typically includes a nurse, a gynecologist, a doctor who’s specialized in female reproductive health; a gynecologic oncologist, a doctor who knows about cancers of the female reproductive system; and oncologists, doctors who use radiation, chemotherapy, and other medicines to treat cancer (1). Care may also include a social worker, a mental health clinician, or the patient’s clergyperson (2).

NURSING CARE

• Assess cultural needs, attitude, and traditions

• Assess patient and family for knowledge deficit and anxiety. Share education and encourage dialogue. Provide emotional support.

• Monitor vital signs, all physiologic systems; report abnormalities to provider (2)

• Frequently assess for pain (2)

• Review medications, discharge and home health guidelines with patient and family (2)

• Educate on the appropriate care after local cervical ablation therapies: Refrain from sex, avoid tampons and douching, shower rather than tub, avoid lifting heavy objects, report heavy vaginal bleeding, foul-smelling drainage, or fever (3).

DISEASE PROCESS

• Cervical cancer is the result of abnormal cellular growth.

• The progression of cervical cancer “starts in the cells lining the cervix – the lower part of the uterus” ( 1, para. 1). The cervix is comprised of glandular and squamous cells: the transformation zone is the area where the two cell types meet, and is “where most cell abnormalities occur” ( 3, p. 1469).

• Most cases are caused by specific strains of HPV , especially strains 16 and 18 (3)

1. Pap: collection of cells from cervix which are then examined in the lab to detect pre cancer or cancer (1)

2. HPV-typing DNA test: detects the presence of HPV, the virus that causes cervical cancer (1). Certain types of HPV, 16 + 18, increase cervical cancer risk (1)

3. Colposcopy: acetic acid solution is applied to the cervix. The provider looks for signs of dysplasia or cancer (2).

4. Biopsies: removal of tissue to test for cancer

5. Endocervical curettage: scraping of the endocervix wall; tissue sample examined in lab for signs of cervical cancer (2)

DIAGNOSTIC ASSESSMENT RISK FACTORS PREVENTATIVE SCREENING

VACCINES (for females and males)

1. HPV vaccines protect against certain HPV infections

a. Ideally, the vaccine is administered before the first sexual contact. This is a means “to receive protection against the highest-risk HPV types that are responsible for most cervical cancers” (3, p. 1469).

b. Types: Gardasil and Cevarix c. Who: Females, ages 9-26 (3)

i. Males, ages 9-26, to protect against genital warts (3)

d. Must receive the vaccine’s entire series - 3 injections over 6 months (3)

SCREENINGS (for females only)

1. Pelvic exams a. Start at age 21; part of well

women visit (3)

2. Pap tests a. Start at age 21 – may be earlier

depending on sexual history (3) b. Ages 21-29: Pap every 3 years (3) c. Ages 30-65: Pap + HPV test every

5 years (3) d. 65 and older: Pap no longer

recommended, so long as history of normal results (3)

3. Screening timeline is subject to change. A more frequent follow-up, for example, may be the result of a previous abnormal result (1)

Risk factors are things that increase one’s chance of getting a disease like cancer (1)

• “Infection by HPV is the most important risk factor for cervical cancer” (1, para. 1).

• Becoming sexually active at a young age: < 18 years of age (1)

o Many sexual partners; a sexual partner who is high-risk (1)

• Smoking o “Women who smoke are about

twice as likely as non-smokers to get cervical cancer” (1, para. 2).

• HIV: a weakened immune system increases a person’s risk for HPV infections (1).

• Long-term use of oral contraceptives (1) o “Research suggests that the risk

of cervical cancer goes up the longer a woman takes oral contraceptives, but the risk goes back down again after the pills are stopped” (1, para. 19).

• Family history of cervical cancer (1)

• Economic status: lower-income women lack easy access to adequate healthcare (1)

TREATMENT

SURGICAL: There are many options: factors to consider include “patient overall health, desire for future childbearing, tumor size and stage, cancer cell type, degree of lymph node involvement, and patient preference” (3, p. 1470). Cervical ablation procedures are the choice for early-stage management and include the following: Laser therapy, which utilizes a laser beam to absorb fluid from the abnormal tissue; cryotherapy, which freezes off the abnormal cells, and the loop electrosurgical excision procedure, or LEEP, in which a thin loop-wire electrode transmits an electrical current to cut away the tissue. A total hysterectomy may be considered if the woman does not want children (3).

NONSURGICAL: Radiation therapy is used to treat invasive cervical cancer (3). Depending on extent and location, therapy may involve brachytherapy or external beam radiation (2). Later-stage disease is often treated with a combination of radiation + chemotherapy (3).