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Chapter 06 Promoting Reproductive Health Through an Understanding of Cervical Cytology Screening, Human Papillomavirus, and Cervical Cancer. Human Papillomavirus. DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers

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Human Papillomavirus

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Chapter 06Promoting Reproductive Health Through an Understanding of Cervical Cytology Screening, Human Papillomavirus, and Cervical Cancer


Human Papillomavirus

  • DNA tumor virus

  • Associated with premalignant/malignant cervical disease and other cancers

  • Over 100 virus types with various manifestations (common warts, plantar warts, skin cancers, anal/genital warts)

  • Most common STD in the U.S.


The Uterine Cervix

  • Squamous epithelium

  • Columnar epithelium

  • Meet at the squamocolumnar junction

  • Squamous metaplasia: process of change from columnar to squamous cellls

  • Transformation zone: area between old and new SCJ


Cervical Cancer Screening

  • Papanicolaou (Pap) test - 1940s

    • Cytological study for detecting cancer

    • Worldwide, most widely used cancer screening method

    • Can detect 95% of all cervical cancers and precancerous abnormalities

    • Dramatically reduces cervical cancer death rates


Cervical Cancer Screening

  • Begin at age 21

  • Every 2 years ages 21–29

  • Age 30+: if three consecutive negative results, screen every 3 years unless special risk factors

    • HIV+ or DES or previous cervical cancer

    • Immunosuppressed


Optimizing Cervical Cancer Screening

  • Collect cytology sample at mid-cycle

  • Teach patients: for 24–48 hours prior to testing

    • Avoid intercourse

    • Avoid vaginal medications

    • Avoid douching

  • Document all communication re: Pap testing


Cervical Cancer Screening in Older Women

  • May discontinue after age 65–70 if three consecutive negative tests and no abnormal test findings in previous 10 years (ACS,USPSTF, ACOG)


Management of Abnormal Cervical Cytology Results

  • Cryosurgery

  • Laser ablation

  • Conization

    • Cold knife

    • Laser

    • Loop electrosurgical excision procedure


High Risk HPV

  • Produces no symptoms

  • Detected by DNA testing

  • Primary cause of cervical neoplasia

  • Persistent infection associated with cervical cancer


HPV DNA Testing

  • Performed on vaginal/cervical cell sample collected for a Pap test

  • Assesses for one or more potentially cancer-causing HPV types

  • Recommended for women 30+ years old


HPV Infection: Manifestations

  • Abnormal Pap test results

  • External genital warts (1%)

    • Condylomaacuminata, smooth papular warts, keratotic genital warts, flat warts

  • Cervical lesions (10%)

    • Majority heal through natural immune response

    • Some persist and progress to cervical cancer


HPV Infection/HPV-Related Cervical Disease: Risk Factors

  • Cigarette smoking

  • Greater than three lifetime sex partners

  • New sex partner within past 12 months

  • Drug use within past 12 months

  • Intercourse while alcohol-impaired

  • Never married


Patient Teaching to Reduce Cervical Cancer Risk

  • Healthy lifestyle

    • Diet

    • Avoid chemical/environmental hazards

    • Sexual health awareness (e.g., condoms, monogamous relationship)

    • Prophylactic HPV vaccination


HPV Vaccines

  • Gardasil – HPV types 6, 11, 16, 18

    • Also approved for use in males

  • Cervarix – HPV types 16, 18

  • Three intramuscular injections

  • Ideally administered before initiation of sexual activity

  • Avoid during pregnancy


Cervical Cancer

  • Squamous cell carcinoma (80%–90%)

  • Adenocarcinoma

  • Typically slow growing, begins as dysplasia (pre-cancerous condition)

    • Detected by Pap test

    • 100% curable


Cervical Cancer Risk Factors

  • HPV infection, immunosuppression

  • Cigarette smoking, alcoholism, poor nutrition

  • Co-infection with other STDs

  • Early onset of sexual activity, multiple sexual partners, early age first full-term pregnancy

  • Inadequate cervical screening

  • In utero DES exposure

  • Family history of cervical cancer


Cervical Cancer Symptoms

  • When present, may include

    • Continuous vaginal discharge

    • Abnormal vaginal bleeding

    • Heavier, longer menstrual periods

    • Loss of appetite, weight loss

    • Fatigue

    • Pelvic pain, back pain, leg pain


Cervical Cancer Work-Up

  • To determine spread, testing may include

    • X-ray computed tomography

    • Magnetic resonance imaging

    • Positron emission tomography

    • Cystoscopy

    • Chest x-ray

    • Intravenous pyelogram


Cervical Cancer Treatment

  • Dependent upon cancer stage

  • May include

    • Surgery

    • Radiation therapy

    • Chemotherapy

    • Biological therapy


Chemotherapy for Cervical Cancer

  • Used for metastatic or recurrent cancer

  • May be oral or intravenous

  • May be used in combination with other chemotherapeutic agents

  • May be combined with RT or surgery


Chemotherapy Patient Teaching

  • Common side effects

    • Nausea and vomiting

    • Change in appetite, oral lesions

    • Vaginal sores

    • Temporary hair loss

    • Fatigue

    • Anemia, bruising, skin rash, infection susceptibility

    • Menstrual cycle changes, infertility

    • Pain, swelling in legs and feet


Biological Therapy

  • Used for metastatic cancer

  • Interferon most common therapy

  • Sometimes combined with chemotherapy

  • Usually administered on outpatient basis

  • Counsel about side effects: flu-like symptoms, rash, anorexia, bruising


Nursing Role in Cervical Health Promotion

  • Education – all ages

    • Cervical cancer screening

    • Cervical cancer symptoms

    • Relationship between HPV and cervical cancer

    • Strategies to reduce HPV risk

  • Support for state, federal funding


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