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Cervical Cancer Information - Causes, Sign & Symptoms & Treatment of Cervical Cancer

Alternative names : Cancer - cervix

The third most common cancer of the female reproductive system, cervical cancer is classified as either preinvasive or invasive. Preinvasive carcinoma ranges from minimal cervical dysplasia, in which the lower third of the epithelium contains abnormal cells, to carcinoma in situ, in which the full thickness of epithelium contains abnormally proliferating cells (also known as cervical intraepithelial neoplasia).

Preinvasive cancer is curable 75% to 90% of the time with early detection & proper treatment. If untreated (& depending on the form in which it appears), it may progress to invasive cervical cancer.

In invasive carcinoma, cancer cells penetrate the basement membrane & can spread directly to contiguous pelvic structures or disseminate to distant sites by lymphatic routes. Invasive carcinoma of the uterine cervix is responsible for 8,000 deaths annually in the United States alone.

In almost all cases (95%), the histologic type is Squalors cell carcinoma, which varies from well-differentiated cells to highly anaplastic spindle cells. Only 5% are adenocarcinomas. Usually, invasive carcinoma occurs between ages 30 & 50; rarely, under age 20.

reason of cervical cancer

Although the cause is unknown, several predisposing factors have been related to the development of cervical cancer: intercourse at a young age (under age 16), multiple sexual partners, multiple pregnancies, & herpesvirus II & other bacterial or viral venereal infections.

The risk factors for cervical cancer are:

• Infection with the virus that reason genital warts (human papilloma virus or HPV) may increase the risk of developing dysplasia & subsequent cancer. Fortunately, not all women who have had HPV infection or genital warts develop cervical cancer. Some scientists believe that other factors, such as smoking, may increase the risk of developing cervical cancer in those who have had HPV.
• Women whose immune systems are weakened -- such as those with HIV infection or women who have received organ transplants & are taking drugs to suppress the immune system -- may be at a higher risk.
• oor women may be at higher risk because they are uninsured or not able to afford regular pap smears.

Signs & symptoms of cervical cancer

Diagnosis of cervical cancer

Staining with Lugol's solution (strong iodine) or Schiller's solution (iodine, potassium iodide, & purified water) may identify areas for a biopsy when the smear shows abnormal cells but there's no obvious lesion. Although the tests are nonspecific, they do distinguish between normal & abnormal tissues: Normal tissues absorb the iodine & turn brown; abnormal tissues are devoid of glycogen & won't change color.

Additional studies, such as lymphangiography, cystography, & scans, can detect metastasis.

Treatment & cure of cervical cancer

Appropriate treatment depends on accurate clinical staging. Preinvasive lesions may be treated with a total excisional biopsy, cryosurgery, laser destruction, conization (& frequent Pap test follow-up) or, rarely, hysterectomy. Therapy for invasive Squalors cell carcinoma may include radical hysterectomy & radiation therapy (internal, external, or both).

Radiation or chemotherapy may be used to treat cancer that has spread beyond the pelvis, or has recurred. There are two kinds of radiation treatment: a device loaded with radioactive pellets which is placed into the vagina near the cancer & kept in place for a certain period of time, or an external device which beams radiation into the target areas during visits to the radiotherapist. A variety of chemotherapeutic drugs, or combinations of them, are used. Sometimes radiation & chemotherapy are used before or after surgery.

Special considerations or prohibition

• If the patient needs a biopsy, drape & prepare her as for a routine Pap test & pelvic examination. Have a container of formaldehyde ready to preserve the specimen during transfer to the pathology laboratory. Explain to the patient that she may feel pressure, minor abdominal cramps, or a pinch from the punch forceps. Reassure her that pain will be minimal because the cervix has few nerve endings.
• If the patient is having cryosurgery, drape & prepare her as for a routine Pap test & pelvic examination. Explain that the procedure takes approximately 15 minutes, during which time refrigerant will be used to freeze the cervix. Warn the patient that she may experience abdominal cramps, head­ache, & sweating, but reassure her that she'll feel little, if any, pain.
• If the patient needs laser therapy, drape & prepare her as for a routine Pap test & pelvic examination. Explain that the procedure takes approximately 30 minutes & may cause abdominal cramps.
• Tell the patient to expect a discharge or spotting for about I week after an excisional biopsy, cryosurgery, or laser therapy, & advise her not to douche, use tampons, or engage in sexual intercourse during this time. Tell her to watch for & report signs of infection. Stress the need for a follow-up Pap test & a pelvic examination within 3 to 4 months after these procedures & periodically there after.
• Tell the patient what to expect post­operatively if she'll have a hysterectomy.
• After surgery, monitor vital signs every 4 hours.
• Watch for signs & symptoms of complications, such as bleeding, abdominal distention, severe pain, & breathing difficulties.
• Administer analgesics, prophylactic antibiotics, & subcutaneous heparin as needed.
• Encourage the patient to perform deep-breathing & coughing exercises.
• Find out whether the patient is to have internal or external radiation therapy, or both. Usually, internal radiation therapy is the first procedure.
• Explain the internal radiation procedure, & answer the patient's questions. Internal radiation requires a 2- to 3-day facility stay, bowel preparation, a povidone-iodine vaginal douche, a clear liquid diet, & nothing by mouth the night before the implantation; it also requires an indwelling urinary catheter.
• Tell the patient that the internal radiation procedure is performed in the operating room under general anesthesia & that an applicator containing radioactive material (such as radium or cesium) will be implanted.

CLINICAL TIP Remember that safety precautions - time, distance, & shielding - begin as soon as the radioactive source is in place. Inform the patient that she'll require a private room.

• Encourage the patient to lie flat & limit movement while the implant is in place. If she prefers, elevate the Human head of the bed slightly.
• Check vital signs every 4 hours; watch for skin reaction, vaginal bleeding, abdominal discomfort, or evidence of de­hydration. Make sure the patient can reach everything she needs without stretching or straining.
• Assist the patient in range-of-motion arm exercises (leg exercises & other body movements could dislodge the implant). If needed, administer a tranquilizer to help the patient relax & remain still. Organize the time you spend with the patient to minimize your exposure to radiation.
• Inform visitors of safety precautions, & hang a sign listing these precautions on the patient's door.
• Explain that external radiation therapy, when necessary, continues for 4 to 6 weeks on an outpatient basis.
• Teach the patient to watch for & report uncomfortable effects. Because radiation therapy may increase susceptibility to infection by lowering the white blood cell count, warn the patient to avoid persons with obvious infections during therapy.
• Teach the patient to use a vaginal dilator to prevent vaginal stenosis & to facilitate vaginal examinations & sexual intercourse.
• Reassure the patient that this disease & its treatment shouldn't radically alter her lifestyle or prohibit sexual intimacy.

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