cancer of cervix, staging, management and nursing management

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

2. Definition
• 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
•
•
•
•
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infection by HPV virus
early sexual activity
cigarette smoking
oral contraceptives
irregular screening history

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

6. The Cervix
Cervix and nearby organs

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).
Benign growths
(polyps, cysts, or genital warts):
• are rarely a threat to life
• don’t invade the tissues around them
Malignant growths (cervical cancer):
• may sometimes be a threat to life
• can invade nearby tissues and organs
• can spread to other parts of the body

10. How does cervical cancer spread?
Cervical cancer begins in cells on the surface of the cervix.
Over time, the cervical cancer can invade more deeply into
the cervix and nearby tissues.
The cancer cells can spread by breaking away from the
original (primary) tumor. They enter blood vessels or lymph
vessels, which branch into all the tissues of the body.
The cancer cells may attach to other tissues and grow to
form new tumors that may damage those tissues.
The spread of cancer is called metastasis.

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
Abnormal vaginal bleeding
—Bleeding that occurs between regular menstrual periods
—Bleeding after sexual intercourse, douching, or a pelvic exam
—Menstrual periods that last longer and are heavier than before
—Bleeding after going through menopause.
- Increased vaginal discharge
-Pelvic pain
-Pain during sex
- Foul smelling discharge

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
Staging
•
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.

23. Treatment
Women with cervical cancer have
many treatment options.
The options are
Surgery
Radiation Therapy
Chemotherapy
or a combination
of methods.
The choice of treatment depends mainly on
the size of the tumor and whether the
cancer has spread. The treatment choice
may also depend on whether the woman
wishes to become pregnant someday.
Cancer treatments often damage healthy
cells and tissues, so side effects are common.
Side effects may not be the same for each
person, and they may change from one
treatment session to the next.

24. Surgical management

25. 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.

26. Radiation therapy

27. Radiation Therapy
 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.

29. Chemotherapy
For the treatment of cervical cancer, chemotherapy is
usually combined with radiation therapy.
For cancer that has spread to distant organs,
chemotherapy alone may be used.
• Chemotherapy uses drugs to kill cancer cells.
• The drugs for cervical cancer are usually given
through a vein (intravenous).
• You may receive chemotherapy in a clinic, at the
doctor’s office, or at home.
• Some women need to stay in the hospital during
treatment.

30. Side effects of chemotherapy

31. 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.

32. 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

33. 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

34. Nursing management
Pre-operative
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•
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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

35. 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

36. 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.

37. 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
•

38. The end