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

Human papillomavirus
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
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
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 screening1
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
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
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
Management of Abnormal Cervical Cytology Results

  • Cryosurgery

  • Laser ablation

  • Conization

    • Cold knife

    • Laser

    • Loop electrosurgical excision procedure

High risk hpv
High Risk HPV

  • Produces no symptoms

  • Detected by DNA testing

  • Primary cause of cervical neoplasia

  • Persistent infection associated with cervical cancer

Hpv dna testing
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
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
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
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
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
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
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
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
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
Cervical Cancer Treatment

  • Dependent upon cancer stage

  • May include

    • Surgery

    • Radiation therapy

    • Chemotherapy

    • Biological therapy

Chemotherapy for cervical cancer
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
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
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
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