Home :: Cervical Cancer
Cervical Cancer Information - Causes, Sign & Symptoms And 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 and proper treatment. If untreated (and depending on the form in which it appears), it may progress to invasive cervical cancer.
In invasive carcinoma, cancer cells penetrate the basement membrane and 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 squamous cell carcinoma, which varies from well-differentiated cells to highly anaplastic spindle cells. Only 5% are adenocarcinomas. Usually, invasive carcinoma occurs between ages 30 and 50; rarely, under age 20.
Causes 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, and herpesvirus II and other bacterial or viral venereal infections.
The risk factors for cervical cancer are:
- Infection with the virus that causes genital warts (human papilloma virus or HPV) may increase the risk of developing dysplasia and 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 and 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 and symptoms of cervical cancer
Preinvasive cervical cancer produces no symptoms or other clinically apparent changes. Early invasive cervical cancer causes abnormal vaginal bleeding, persistent vaginal discharge, and postcoital pain and bleeding. In advanced stages, it causes pelvic pain, vaginal leakage of urine and stool from a fistula, anorexia, weight loss, and anemia.
Diagnosis of cervical cancer
A cytologic examination (Papanicolaou [Pap] test) can detect cervical cancer before clinical evidence appears. (Systems of Pap test classification may vary from facility to facility.) Abnormal cervical cytology routinely calls for colposcopy, which can detect the presence and extent of preclinical lesions requiring a biopsy and histologic examination.
Staining with Lugol's solution (strong iodine) or Schiller's solution (iodine, potassium iodide, and 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 and abnormal tissues: Normal tissues absorb the iodine and turn brown; abnormal tissues are devoid of glycogen and won't change color.
Additional studies, such as lymphangiography, cystography, and scans, can detect metastasis.
Treatment and 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 (and frequent Pap test follow-up) or, rarely, hysterectomy. Therapy for invasive squamous cell carcinoma may include radical hysterectomy and 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 and 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 and chemotherapy are used before or after surgery.
Special considerations or prevention
- If the patient needs a biopsy, drape and prepare her as for a routine Pap test and 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 and prepare her as for a routine Pap test and 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, and sweating, but reassure her that she'll feel little, if any, pain.
- If the patient needs laser therapy, drape and prepare her as for a routine Pap test and pelvic examination. Explain that the procedure takes approximately 30 minutes and 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, and advise her not to douche, use tampons, or engage in sexual intercourse during this time. Tell her to watch for and report signs of infection. Stress the need for a follow-up Pap test and a pelvic examination within 3 to 4 months after these procedures and 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 and symptoms of complications, such as bleeding, abdominal distention, severe pain, and breathing difficulties.
- Administer analgesics, prophylactic antibiotics, and subcutaneous heparin as needed.
- Encourage the patient to perform deep-breathing and 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, and 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, and 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 and that an applicator containing radioactive material (such as radium or cesium) will be implanted.
CLINICAL TIP Remember that safety precautions - time, distance, and 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 and limit movement while the implant is in place. If she prefers, elevate the 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 and other body movements could dislodge the implant). If needed, administer a tranquilizer to help the patient relax and remain still. Organize the time you spend with the patient to minimize your exposure to radiation.
- Inform visitors of safety precautions, and 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 and 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 and to facilitate vaginal examinations and sexual intercourse.
- Reassure the patient that this disease and its treatment shouldn't radically alter her lifestyle or prohibit sexual intimacy.
back to gynaecological problems section