cancer of cervix

cancer of cervix, staging, management and nursing management

1. Cervical Cancer PRESENTED BY TAGE YAJA M.Sc NURSING 1 st YEAR

2. D efinition 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. incidence New Cases 130,000/year Died from CC 20,000~30,000/year

4. Risk Factor infection by HPV virus early sexual activity cigarette smoking oral contraceptives irregular screening history

5. Risk factor ( cont )…. nutritional deficiency ( folate, carotene, vit c) obesity poor immune system (HIV) age (30-39 & 60 -69) diethylstilbestrol

6. The Cervix

7. Pathophysiology

8. Normal pre invasive cancer invasive cancer

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).

10. How does cervical cancer spread ?

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. Symptoms

13. Diagnostic evaluation

14. PAP smear collection.

15. Cytologic test PAP smear ( Papanicolaou ) Blood test Colposcopic test Cervical biopsy and Endocervical Curettage Imaging studies CT Scan MRI X ray

16. Cervical Cancer 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. Staging

17. Treatment

18. Surgical management

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. Radiation therapy

21. 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. Radiation Therapy

22. Chemotherapy

23. Side effects of chemotherapy

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. 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. 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. 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. 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. 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. 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. The end