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• Abnormal vaginal bleeding • An unusual discharge from the vagina • Pain during intercourse
IN ADVANCED STAGES: • Pelvic pain • Vaginal leakage of urine or stools from a fistula • Anorexia • Weight loss • Anemia
the lower third of the epithelium contains abnormal cells. Pre-invasive Carcinoma • Ranges from minimal cervical dysplasia. to carcinoma in situ • The full thickness of epithelium contains abnormally proliferating cells • Curable 75% to 90% of the time with early detection and proper treatment. .Classified as either preinvasive / invasive carcinoma 1.
2. invasive carcinomas occurs between ages 30 and 50. under age 20 . • Usually. rarely. Invasive Cervical Cancer • Cells penetrate the basal membranes and can spread directly to contagious pelvic structures or disseminate to distant sites by lymphatic routes.
. • If the disease involves the liver. • Bimanual pelvic examination findings often reveal pelvic or parametrial metastasis.Physical Examination • Rectal examination may reveal an external mass or gross blood from tumor erosion. • Leg edema suggests lymphatic or vascular obstruction caused by tumor. hepatomegaly may develop.
clinical staging estimates the extent of the disease so that treatment can be planned more speciﬁcally and prognosis reasonably predicted. • In later stages. reddish growth or a deep. ulcerating lesion. pelvic examination may reveal a large. invasive cervical cancer is found microscopically by Pap smear. The patient may report spotting or bloody discharge. • When the patient has been diagnosed with invasive cervical cancer.Assessment and Diagnostic Findings • In its very early stages. The .
• Ask the woman if she has a watery. • Ask the patient is she has had or now has bleeding. vaginal bleeding.Physical assessment/clinical manifestations • The patient who has preinvasive cancer often asymptomatic. • The classic symptom of invasive cancer is painless. blood tinged vaginal discharge that becomes dark and foul smelling .
• Flank pain may be a late symptom of hydronephrosis (water inside the kidney) .• Leg pain (along the sciatic nerve) or swelling of one leg may be a late symptom may indicate recurrent disease.
Ask the patient if she has had other signs of recurrence or metastasis such as: • Unexplained weight loss • Dysuria (painful urination) • Pelvic pain(cause by pressure of the tumor on the bladder or the bowel) • Hematuria (blood in the urine) • Rectal bleeding • Chest pain .
Surgical management: Early stage I management techniques includes: • local cervical ablation therapies of electrosurgical excision • laser therapy • cryosurgery .
Small tumors that are only microinvasive are managed with: • excisional conization • hysterectomy Early stage invasive cancers are managed with: • radical surgery • and radiation Advanced inoperable cancers are treated with: .
For cervical cancer that has spread beyond the cervix. one of these procedures may be used: • Radical hysterectomy • Exenteration 3 types of exenteration: Anterior exenteration Posterior exenteration Total exenteration .
Non surgical management: • Radiation therapy is reserved for stage 2 invasive cervical cancer. radiation therapy is as effective as a radical hysterectomy . For cancer that has extended beyond the cervix but not to the pelvic wall.
Medical management • Cryotherapy (freezing with nitrous oxide) • Laser therapy • Loop electrosurgical excision procedure • Simple hysterectomy if invasion is less than 3mm. Radical trachelectomy is an alternative to hysterectomy .
• Drugs most often used to treat cervical cancer include: • Cisplatin • Carboplatin • Paclitaxel (Taxol®). • Topotecan • Gemcitabine (Gemzar®) .
• Common side effects of chemotherapy can include: • Nausea and vomiting • Loss of appetite • Loss of hair • Mouth sores • Fatigue (tiredness) .
Because chemotherapy can damage the bloodproducing cells of the bone marrow. This can result in: • An increased chance of infection (from a shortage of white blood cells) • Bleeding or bruising after minor cuts or injuries (because of a shortage of blood platelets) • Shortness of breath (due to low red blood cell counts) . the blood cell counts might become low.
Things to do to prevent pre-cancers • • • • Avoid being exposed to HPV Use of Condoms Don't smoke Get vaccinated .
fears about sexuality.• Related Nursing Diagnosis: • Anxiety related to diagnosis of cancer. and relationships with partner and family • Pain related to surgery and other adjuvant therapy • Deficient knowledge of perioperative aspects of hysterectomy and self care . fear of pain perceived loss of femininity and disfigurement • Disturbed body image related to altered fertility.
Collaborative problems/ potential complications • Hemorrhage • Deep vein thrombosis • Bladder dysfunction .
and prognosis Acknowledge patient concenrs about ability to have children. impact on sexual relations . loss of femininity. significant others. religious belief.Nursing interventions • Relieving anxiety Determine how this experience affects the patient and allow the patient to verbalize feelings and identify strengths • Improving body image Assess how patient feels about undergoing a hysterectomy related to the nature of diagnosis.
• Educate patient about sexual relations • Exhibit interest. concern and willingness to listen to fears Relieving pain • Administer analgesics to relieve pain and promote movement and ambulation • Apply heat to abdomen or insert a rectal tube if prescribed for abdominal distention .
purulent drainage or discharge • Stress the importance of adequate oral intake and maintaining bowel and urinary tract function • Teach that showers are preferable to tub baths to reduce risk for infection and injury getting in and out the tub . no sitting for long periods. post operative fatigue should gradually decrease • Instruct pt to check surgical incision daily and report redness.Promoting home and community based care Teaching patients self care • Instruct pt to resume activities gradually.
Continuing care • Make follow up telephone contact with patient to address concerns and determine progress • Remind patient to discuss hormone replacement therapy with primary physician. if ovaries are removed • Reinforce information regarding resumption of sexual intercourse .