1. Adult Medical-Surgical Nursing
Reproductive Health Module: Cervical Cancer

2. Cervical Cancer: Description
Carcinoma of the cervix of the uterus is mainly squamous cell
Classification:
CIN I and II (Cervical Intra-epithelial Neoplasia): mild to moderate dysplasia
CIN III: severe dysplasia (carcinoma in situ). Still pre-invasive
Invasive carcinoma

3. Cervical Cancer: Aetiology
Mainly occurs in younger women (child-bearing age)
Multiple sex partners and unprotected sex
Smoking; malnutrition; drug abuse
*Chronic genital infection especially HPV: Human Papilloma Virus (genital wart virus)
Other sexually transmitted diseases (STD) as genital herpes, chlamydia, gonorrhoea, HIV

4. Cervical Cancer: Clinical Manifestations
Intermenstrual bleeding per vagina
Bleeding after intercourse
Watery or foul-smelling vaginal discharge (advanced)
Possibly post-menopausal bleeding

5. Cervical Cancer: Diagnosis/ Screening for Early Detection
Papanicolau cervical smear (Pap smear): cells scraped from inside the cervical canal. Yearly screening advised
If abnormal Pap smear:
Cone biopsy (wide wedge of surrounding tissue excised for examination/ staging)
Colposcopy (examination of the uterus)
If invasive: further tests to assess extent

6. Invasive Cervical Cancer: Further Tests to Assess Extent of Disease
D&C (Dilatation and Curettage)
MRI
CT scan
IVP
Barium studies (bowel)
Bone scan

7. Cervical Cancer: Prevention
Health Education:
Avoid multiple partners/ unprotected sex
Seek optimum health and nutritional status
↓ smoking
↓ drug and alcohol abuse
Annual screening through Pap Smear
Vaccination for HPV now being used as public health measure

8. Cervical Cancer: Management
CIN I and II (pre-invasive):
Cryotherapy (nitrous oxide freezing) or laser to remove
Regular follow-up with Pap smear
CIN III (also pre-invasive):
Cone biopsy, colposcopy, laser or cryotherapy
Careful regular follow-up
Post-childbearing, hysterectomy an option

9. Invasive Cervical Cancer: Management
Further tests to assess extent of disease
Staging (TNM):
Tumour, Nodes, Metastases
Radical surgery: Total Hysterectomy and Bilateral Salpingo-oophrectomy
Radiation therapy: external beam and brachytherapy (internal pack)
Chemotherapy

10. Cervical Cancer: Nursing Considerations
Clear health education related to:
Lifestyle measures
Regular Pap smear
Vaccination for HPV
Emotional and psychological support to patient and family involved in treatment