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.

Estimated new cases and deaths from cervical (uterine cervix) cancer in the United States in 2010:

 New cases: 12,200

 Deaths: 4,210

Symptoms
Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can
include:

 Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-
smelling
 Abnormal vaginal bleeding between periods, after intercourse, or after menopause
 Periods become heavier and last longer than usual
 Any bleeding after menopause

Symptoms of advanced cervical cancer may include:

 Loss of appetite
 Weight loss
 Fatigue
 Pelvic pain
 Back pain
 Leg pain
 Single swollen leg
 Heavy bleeding from the vagina
 Leaking of urine or feces from the vagina
 Bone fractures

PREDISPOSING FACTOR

Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common
virus that is spread through sexual intercourse. There are many different types of HPV. Some
strains lead to cervical cancer. (Other strains may cause genital warts, while others do not
cause any problems at all.)

Other risk factors for cervical cancer include:

 Having sex at an early age

  Multiple sexual partners
 Sexual partners who have multiple partners or who participate in high-risk sexual
activities
 Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the
early 1960s to prevent miscarriage
 Weakened immune system
 Poor economic status (may not be able to afford regular Pap smears)

Exams and Tests

Precancerous changes of the cervix and cervical cancer can not be seen with the naked eye.
Special tests and tools are needed to spot such conditions.

Pap smears screen for precancers and cancer, but do not offer the final diagnosis. If abnormal
changes are found, the cervix is usually examined under magnification. This is
called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and
sent to a laboratory for examination.

Other tests may include:

 Endocervical curettage (ECC) to examine the opening of the cervix

 Cone biopsy

If the woman is diagnosed with cervical cancer, the health care provider will order more tests to
determine how far the cancer has spread. This is called staging. Tests may include:

 CT scan
 Cystoscopy
 MRI
 Chest x-ray
 Intravenous pyelogram (IVP)

Treatment
Treatment of cervical cancer depends on the stage of the cancer, the size and shape of the
tumor, the age and general health of the woman, and her desire to have children in the future.

Early cervical cancer can be cured by removing or destroying the precancerous or cancerous
tissue. There are various surgical ways to do this without removing the uterus or damaging the
cervix, so that a woman can still have children in the future.

Types of surgery for early cervical cancer include:

  LEEP (loop electrosurgical excision procedure) -- uses electricity to remove abnormal
tissue
 Cryotherapy -- freezes abnormal cells
 Laser therapy -- uses light to burn abnormal tissue

A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical
cancer that has not spread. It may be done in women who have repeated LEEP procedures.

Treatment for more advanced cervical cancer may include:

 Radical hysterectomy, which removes the uterus and much of the surrounding tissues,
including internal lymph nodes and upper part of the vagina.
 Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis,
including the bladder and rectum, are removed

Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has
returned. Radiation therapy is either external or internal.

 Internal radiation therapy uses a device filled with radioactive material, which is placed
inside the woman's vagina next to the cervical cancer. The device is removed when she
goes home.
 External radiation therapy beams radiation from a large machine onto the body where
the cancer is located. It is similar to an x-ray.

Chemotherapy uses drugs to kill cancer. Some of the drugs used for chemotherapy for cervical
cancer include 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide.
Sometimes radiation and chemotherapy are used before or after surgery.

CERVICAL CANCER
  Is a common gynecologic malignancy.
 Most commonly occurs in women age 35 to 55.
 Major risk factors include early sexual activity, multiple sexual partners, and history of sexually
transmitted diseases especially human papilloma virus and herpes simplex virus.
 Cervical cancer may involve the bladder, rectum, and may metastasize to the lungs,
mediastinum, bones, and liver.
 Types of cervical cancer includes:
 Dysplasia – atypical cells with some degree of surface maturation.
  Carcinoma in Situ (CIS) – which is confined to the cervical epithelium.
 Invasive carcinomas – the stroma is involved, 90% are of the squamous cell type.
 Invasive cancer – spreads by local invasion and lymphatic’s to the vagina and beyond.
Assessment
1. Early disease is usually asymptomatic.
2. Initial symptoms are postcoital bleeding, irregular vaginal bleeding or spotting between periods or
after menopause, and malodorous discharge.
3. As disease progresses, bleeding becomes more constant and is accompanied by pain that
radiates to buttocks and legs.
4. Weight loss, anemia, and fever signal advance disease.
Diagnostic Evaluation
1. 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%.
2. If Pap test is abnormal, colposcopy, and biopsy or conization may be done.
3. Additional testing includes metastatic workup (chest x-ray, I.V. urogram, cystoscopy, barium
studies of colon and rectum, sigmoidoscopy)
Therapeutic Interventions
1. Intracavitary radiation for earlier localized stages – radium by way of applicator in endocervical
canal.
2. External radiation for generalized pelvis effect in later stages.
3. Laser therapy may be used to treat dysplasia.
4. Chemotherapy may be used as adjuvant to surgery or radiation treatments.
Surgical Interventions
1. Conization is performed for microinvasize stage if child-bearing is desired.
2. Cryosurgery, laser ablation, and loop electrosurgical excision procedure may be done for
dysplasia or CIS.
3. Hysterectomy, simple or radical depending on stage.
4. Pelvic exenteration for very advanced disease if radiation therapy cannot be used; also for
recurrent cancer.
Nursing Interventions
1. During intracavitary radiation, check radioisotope applicator position every 8 hours, and monitor
amount of bleeding and drainage (a small amount is normal).
2. Observe for signs and symptoms of radiation sickness such as nausea, vomiting, fever, diarrhea,
abdominal cramping.
3. Monitor for complications of surgery – bleeding, infection.
4. Help the patient seek information on stage of cancer, treatment options.
5. Provide emotional support during treatment.
6. Advise patient to discharge after surgical procedures and need to report excessive, foul-smelling,
discharge or bleeding.
7. Explain the importance of life-long follow up regardless of treatments to determine the response
to treatment and to detect spread of cancer.
8. Encourage all women to receive regular cervical cancer screening.
Nursing Interventions: Cervical Cancer
 9. Listen to the patient’s fears and concerns, and offer reassurance when
appropriate.
10. Encourage the patient to use relaxation techniques to promote comfort during the
diagnostic procedures.
11. Monitor the patient’s response to therapy through frequent Pap tests and cone
biopsies as ordered.
12. Watch for complications related to therapy by listening to and observing the
patient.
13. Monitor laboratory studies and obtain frequent vital signs.
14. Understand the treatment regimen and verbalize the need for adequate fluid and
nutritional intake to promote tissue healing.
15. Explain any surgical or therapeutic procedure to the patient, including what to
expect both before and after the procedure.
16. Review the possible complications of the type therapy ordered.
17. Remind the patient to watch for and report uncomfortable adverse reactions.
18. Reassure the patient that this disease and its treatment shouldn’t radically alter
her lifestyle or prohibit sexual intimacy.
19. Explain the importance of complying with follow up visits to the gynecologist and
oncologist.

The HPV Vaccine

The human papilloma virus (HPV) vaccine prevents infection with certain serotypes of human
papilloma virus associated with the development of cervical cancer, genital warts, and some less common
cancers.
The HPV vaccine is recommended for 11 and 12 year-old girls. It is also recommended for girls and
women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine
series.
Note: The vaccine is not recommended for pregnant women.