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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 - PowerPoint PPT Presentation
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Chapter 06Promoting Reproductive Health Through an Understanding of
Cervical Cytology Screening, Human Papillomavirus, and Cervical Cancer
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.
Human Papillomavirus
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
The Uterine Cervix
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
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
Optimizing Cervical Cancer Screening
May discontinue after age 65–70 if three consecutive negative tests and no abnormal test findings in previous 10 years (ACS,USPSTF, ACOG)
Cervical Cancer Screening in Older Women
Cryosurgery Laser ablation Conization
◦ Cold knife ◦ Laser◦ Loop electrosurgical excision procedure
Management of Abnormal Cervical Cytology Results
Produces no symptoms Detected by DNA testing Primary cause of cervical neoplasia Persistent infection associated with cervical
cancer
High Risk HPV
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 DNA Testing
Abnormal Pap test results External genital warts (1%)
◦ Condyloma acuminata, 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: Manifestations
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
HPV Infection/HPV-Related Cervical Disease: Risk Factors
Healthy lifestyle◦ Diet◦ Avoid chemical/environmental hazards◦ Sexual health awareness (e.g., condoms,
monogamous relationship)◦ Prophylactic HPV vaccination
Patient Teaching to Reduce Cervical Cancer Risk
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
HPV Vaccines
Squamous cell carcinoma (80%–90%) Adenocarcinoma Typically slow growing, begins as dysplasia
(pre-cancerous condition)◦ Detected by Pap test◦ 100% curable
Cervical Cancer
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 Risk Factors
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 Symptoms
To determine spread, testing may include◦ X-ray computed tomography◦ Magnetic resonance imaging◦ Positron emission tomography◦ Cystoscopy◦ Chest x-ray◦ Intravenous pyelogram
Cervical Cancer Work-Up
Dependent upon cancer stage May include
◦ Surgery◦ Radiation therapy◦ Chemotherapy◦ Biological therapy
Cervical Cancer Treatment
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 for Cervical Cancer
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
Chemotherapy Patient Teaching
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
Biological Therapy
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
Nursing Role in Cervical Health Promotion
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