CERVICAL CANCER(CACX)- Mr B Moobela.pptx

Cervical Cancer

1. CERVICAL CANCER(CACX) MR.MOOBELA

2. SPECIFIC OBJECTIVES At the end of the lecture/discussion, students should be able to: Define cervical cancer. State the causes of cervical cancer. Describe signs and symptoms of cacx Describe the cacx staging and management In Details explain the prevention of cacx GENERAL OBJECTIVE At the end of the lecture/discussion, students should be able to demonstrate an understanding on cancer of the cervix.

3. Cervical cancer is cancer that starts in the cervix, the lower part of the uterus. It is the third most common cancer in women worldwide. Cervical cancer remains a significant cause of morbidity and mortality in developing countries due to the lack of access to early detection and treatment services. INTRODUCTION

4. 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. Cervical cancer is almost always caused by human papilloma virus (HPV) infection ( stedmans ’ electronics medical dictionary, 2009) DEFINITION

5. Cigarette Smoking Women who smoke are at risk of having cacx . Smoking exposes the body to many cancer-causing chemicals (Nicotine) that affect organs other than the lungs. These harmful substances are absorbed through the lungs and carried in the bloodstream throughout the body . Tobacco by-products have been found in the cervical mucus of women who smoke. Smoking also makes the immune system less effective in fighting HPV infections . PREDISPOSING FACTORS

6. Immunosuppression Human immunodeficiency virus (HIV), damages the body's immune system and places women at higher risk for HPV infections. This may explain the increased risk of cervical cancer for women with AIDS. CONT…

7. The immune system is important in destroying cancer cells and slowing their growth and spread. CONT…

8. Chlamydia infection Chlamydia is a relatively common kind of bacteria that can infect the female reproductive system. It is spread by sexual contact. Untreated Chlamydia infection can cause repeated pelvic inflammation, leading to cervical cancer CONT..

9. Diet - Women with diets low in fruits and vegetables may be at increased risk for cervical cancer due to low immunity. Also overweight women are more likely to develop adenocarcinoma of the cervix as fat produces oestrogen which in turn promotes proliferation of body tissues including cervical tissue. Oral contraceptives (birth control pills) - There is evidence that taking oral contraceptives (OCs) for a long time increases the risk of cancer of the cervix especially the COCs as they cause the over growth of the body tissues. CONT…

10. Young age at the first full-term pregnancy - Women who are younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older as the immature cervix is subjected to severe trauma. Poverty Poverty is also a risk factor for cervical cancer. Many women with low incomes do not have ready access to adequate health care services, including Pap tests. This means they may not get screened or treated for cervical pre-cancers. CONT…

11. Family history of cervical cancer Cervical cancer may run in some families. If your mother or sister had cervical cancer, your chances of developing the disease are 2 to 3 times higher than if no one in the family had it. PREDISPOSING FACTORS CONT…

12. Sexual history. Women who have had many sexual partners have a higher risk of developing cervical cancer. Also, a woman who has had sex with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher risk of HPV infection CONT…

13. Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include: Vaginal bleeding between periods, after intercourse, or after menopause Any bleeding after menopause may be linked to cacx Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling Menses become heavier and last longer than usual. Lower abdominal pains SIGNS AND SYMPTOMS

14. Symptoms of advanced cervical cancer may include : Back pain due to metastasis. Fatigue/weakness due to anorexia Heavy bleeding from the vagina Leaking of urine or feces from the vagina due to fistula formation. Loss of appetite leading to weight loss. Pelvic pain due to metastasis to other organs. Cont …

15. Once cervical cancer has been diagnosed the stage needs to be determined. A stage reveals how much the cancer has progressed. Cervical Cancer has five different categories in its staging system. The system used is referred to as the " Figo " system (International Federation of Gynecology and Obstetrics). STAGING OF CERVICAL CANCER

16. Stage 0 indicates early cervical cancer, while stage 4 indicates advanced cervical cancer. The stage at diagnosis is one factor that determines the treatment options available. Stage 0: Also called "carcinoma in situ", stage 0 indicates non-invasive cervical cancer. In this stage, cancerous cells are only found on the surface of the cervix. Stage 0 cervical cancer is highly treatable and has an excellent survival rate. Stg cont …

17. Stage I - : The tumor has invaded the cervix beneath the top layer of cells. Cancer cells are found only in the cervix. IA – there are no visible lesions and is less than 5mm in depth. IB _neoplasm confined to the cervix. Cont …

18. 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 (the lining of the part of the body between the hips). The tumor does not invade the lower third of the vagina or the pelvic wall . Stg cont …

19. IIA – neoplasm has infiltrated tissue or upper vagina. If the carcinoma is endo cervical, then it has extended up into the uterus. IIB – tumor extending to the parametrium but not to the pelvic wall. Cont …

20. Stage III - extends to pelvic wall or lower 1/3 of the vagina. IIIA - involves lower 1/3 of vagina IIIB - extends to pelvic wall and/or causes non-functioning kidney. Stg cont ….

21. Stage IV : The tumor invades the bladder or rectum. Or the cancer has spread to other parts of the body. IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis IVB - distant metastasis. Stg cont..

22. INVESTIGATIONS 1..History taking can be done e.g. hx of signs and symptoms, family hx of cancers and drug hx which may include use of contraceptives like COCs. 2..Physical examinations which may indicate some s/s. eg pain on palpation,lyph nodes and other swellings on palpation vaginal, bleeding and pallor. Management.

23. Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions. 3.Pap smears screen for precancers and cancer, but do not make a final diagnosis . Pap smear is a microscopic examination of cells scraped from the opening of the cervix . It is a screening test for cervical cancer Cells are gently scraped from the cervix area, and sent to a lab for examination Cont …

24. 4..colposcopy If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy . This is a binocular optical device used to magnify and illuminate (lighten) the cervical tissues. Pieces of tissue are surgically removed during this procedure and sent to the laboratory for examination. Cont …

25. 5Cone biopsy A small cone-shaped section of the cervix, that is aimed to be large enough to remove any abnormal cells, is taken for examination under a microscope by a pathologist. It provides a direct histological evaluation of the endometrium for both endocervical disease and exocervical disease. it is a confirmative test. INVESTIGATION CONT…

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

27. 6.Chest x-rays: X-rays often can show whether cancer has spread to the lungs. 7.CT scan :Takes a series of detailed pictures of organs. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan. 8.MRI : is used to make detailed pictures of pelvis and abdomen . An MRI can show whether cancer has spread . 9.Pelvic ultra sound can also be done. Cont..

28. AIMS OF MGT To prevent spread of the cancer. To prevent other complications. To allay anxiety Management of cervical cancer depends on: The stage of the cancer The size and shape of the tumor The woman's age and general health Her desire to have children in the future MANAGEMENT

29. Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are also 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.     Cont …

30. Types of surgery for early cervical cancer include : Loop electrosurgical excision procedure (LEEP) -- uses electricity to remove abnormal tissue Cryotherapy -- freezes abnormal cells Laser therapy -- uses light to burn abnormal tissue Mgt cont …

31. Treatment for more advanced cervical cancer may include : The following surgical procedures may be used: Radical hysterectomy; Surgery to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, or nearby  lymph nodes  may also be removed. Bilateral salpingo -oophorectomy : Surgery to remove both  ovaries  and both  fallopian tubes . Mgt cont …

32. C .Pelvic exenteration ; an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. CONT..

33. 2. Radiotherapy . Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has reoccurred. Radiation therapy is either external or internal. It inhibits cancer cell growth and reduce the blood supply to the cancer cell. Cont ….

34. Indication for radiotherapy Stages three and four of the carcinoma Internal radiation therapy (brachytherapy) uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray. This is called teletherapy .   Cont..

35. Advantages of radiotherapy It can be given on an out-patient basis It avoids intra operative and post operative complications Has a short course treatment Disadvantages of radiotherapy. It has long term effects of radiation on normal tissue such as bladder damage, fistula formation, vagina stenosis and ureteral obstruction Cont …

36. Side Effects of Radiation Therapy Side effects of radiation vary from patient to patient. It all depends on how often treatment is given and at what degree. The three most commonly experienced side effects are: CONT…

37. Fatigue All radiation patients experience some degree of fatigue during treatment. This is the time when a cancer patient should really utilize her support system to help with chores, errands, child care and other small tasks. Short naps throughout the day and getting uninterrupted sleep at night really make a difference in a person's energy level. Cont …

38. Skin Problems The skin that has been exposed to treatment may appear red, sunburned, tan, or irritated. The skin is very sensitive and should be treated as so. Patients should avoid perfumes or scented body lotions, tight fitting clothing, and exposing the area to sun (during treatment and for at least one year after). CONT…

39. Loss of Appetite Loss of appetite can lead to fatigue and nutritional deficiencies. It is very important to keep up strength during any cancer treatment, and nutrition is one of the best resources to do that. Cont …

40. 3 .Chemotherapy Uses drugs to kill cancer cells. Some of the drugs used for cervical cancer chemotherapy include doxorubicin, methotrexate,, and cyclophosphamide . Sometimes radiation and chemotherapy are used before or after surgery . Cont …

41. A] vincrisitne Dose: 1.4mg/m2 IV weekly. Action: arrest mitosis in metaphase, block cell division. Side effects: peripheral neuropathy, headache, ataxia, diarrhea, stomatitis . B] cyclophosphomide Dose: 40-50mg/kg iv in divided doses. Cont …

42. Action: interferres with RNA transcription leading to cell death. Side effects Cardio- toxitiy , anorexia, nausea and vomiting, fertility impairment, reversible alopecia. C] Methotrexate Dose: 10-25 mg orally 4 to 8 days. Side effects. Acute toxicity of the liver, thrombocytopaenia , anaemia , skin rashes, alopecia. Etc Mgt cont …

43. D ] doxorubicin Dose: 60 - 75mg as a single dose for three weeks Action: interferes RNA synthesis. Side effects : cardiac depression, nausea and vomiting, leucopenia, urticaria , complete alopecia etc . Cont ….

44. 4. Hormone therapy Hormone therapy  is a cancer treatment that removes  hormones  or blocks their action and stops cancer  cells from growing. High doses of medroxyprogestorone acetate ( depo-provera ) is used. MGT CONT..

45. Nursing Care nutrition Observation Psychological care Painful Relief Elimination Hygiene NURSING CARE OF THE PATIENT WITH CANCERS OF THE CACX

46. The nursing care to the patient with a cancer of the uterus OR Cervical involves pre and post-operative care for hysterectomy; care before and after radiation and the general care. Care would be individualized. Cont …

47. Nursing care of patients with cancer of the uterus or cervix depends on the stage of cancer and the intervention taken. However these patients may experience a variety of clinical manifestation, Cont …

48. including leucorrhea, irregular vaginal bleeding, vaginal discharge, increase in abdominal pain and pressure, bowel and bladder dysfunction and vulva itching and burning. Assessment for these signs and symptoms is an important nursing responsibility. Some of the nursing problems for these patients may include: Cont..

49. Anxiety related to threat of a malignancy and lack of knowledge about the disease process and prognosis. Acute or chronic pain related to pressure secondary to enlarging tumour Cont..

50. Altered body image related to loss of body parts and loss of good health. Ineffective sexuality patterns related to physiologic limitations. Ineffective breathing pattern related to presence of ascites and effusion if the cancer has metastasized to the lungs and liver. Anticipatory grieving related to poor prognosis of advanced disease.   Cont …

51. Help explore myths and fears, including those shared by family, friends with breast cancer who have received chemotherapy Explain the rationale behind treatment basing on the pathology report. Reinforce the goal of eliminating any residual cancer cells. Reinforce the importance of following treatment schedule to gain the most benefit from chemotherapy. NURSING CARE OF THE PATIENT GOING THROUGH CHEMOTHERAPY

52. Encourage partners or significant others to accompany patients during follow up visits. This allows them to be included in the discussion regarding concerns and problems they are experiencing, whether individually or as a couple. Help patient and family to explore quality of life issues individually or as a family . Cont..

53. In case the woman still wants to have children, encourage and facilitate discussion with appropriate medical resources for pregnancy planning. Encourage healthy lifestyle behaviors such as diet, exercise and stopping alcohol intake Cont …

54. Note: for pregnant women treatment is withheld until after delivery. For women at four weeks gestation the pregnancy is terminated. The risk of delaying treatment for fetal development must be weighed against the risk of progress disease. After 28 weeks gestation the fetus is delivered by caesarean section to reduce the risk of maternal bleeding and the risk of spreading the disease. Cont …

55. Follow up after treatment After treatment for cervical cancer, all patients are examined on a scheduled frequency. At three months interval for the first year, 3-4 months during the 2 nd year, every 6 months for the next three years then annually, beginning five years after treatment. Cont..

56. Follow up after treatment After treatment for cervical cancer, all patients are examined on a scheduled frequency. At three months interval for the first year, 3-4 months during the 2 nd year, every 6 months for the next three years then annually, beginning five years after treatment. Cont..

57. A vaccine to prevent cervical cancer is now available which prevents infection against the two types of HPV responsible for most cervical cancer cases. Practicing safe sex (using condoms) also reduces your risk of HPV and other sexually transmitted diseases. HPV infection causes genital warts. To further reduce the risk of cervical cancer, women should limit their number of sexual partners and avoid partners who participate in high-risk sexual activities . PREVENTION OF CACX.

58. Getting regular Pap smears can help detect precancerous changes, which can be treated before they turn into cervical cancer. Pap smears effectively spot such changes, but they must be done regularly. Annual pelvic examinations, including a pap smear, should start when a woman becomes sexually active, or by the age of 20 in a non sexually active woman. Cont ….

59. Anemia Other infections due to the discharges. Psychological effects. Ectopic pregnancy. Metastasis Multiple organ failure. Infertility. COMPLICATIONS

60. CERVICAL CANCER Mrs. Muulu aged 47 years, is admitted to gynae ward with complaints of lower abdominal pains and PV bleeding after coitus. On examination she looks, cachexic, and pale. A provisional diagnosis of cervical cancer is made, and she is scheduled for radical hysterectomy as an elective procedure . Define radical hysterectomy (5 marks) State five (5) predisposing factors to cervical cancer (2 5 marks) Discuss the pre-operative management of Mrs. Muulu before her surgery (45 marks) State five (5) preventive measures of cervical cancer (25 marks) QUIZ

61. THE END