NURSING AND MIDWIFERY TRAINING COLLEGE, CAPE COAST

COURSE: SURGICAL NURSING

TUTOR: SIS BENIN

LEVEL 200

GROUP THREE

PRESENTATION ON CERVICAL CANCER

OBJECTIVES:

By the end of the presentation, students should be able to

 Define cervical cancer

 State the types of cervical cancer

 Name the causes and risk factors of cervical cancer

 State the clinical features of cervical cancer

 Name the diagnostic investigations used to diagnose cervical cancer

 State the peri-operative preparation and post-operative preparation for cervical cancer

 State the complications and prevention of cervical cancer

 State the medical management and surgical interventions for cervical cancer
THECERVIX

The cervix is the lower portion of the uterus. It forms part of the female reproductive tract. It
connects the vagina with the main body of the uterus, acting as a gateway between them. The
cervix is made up of two(2) parts and is covered with two different types of cells, thus;

ENDOCERVIX: is the opening of the cervix that leads into the uterus. It is covered with
glandular cells.
EXOCERVIX(ECTOCERVIX): is the outer part of the cervix that can be seen by the doctor
during a speculum exam. It is covered in squamous cells. The place where these two cell types
meet in the cervix is called the Transformation zone.

DEFINITION OF CANCER AND CERVICAL CANCER

Cancer is the abnormal cell growth with the potential to invade or spread to other parts of the
body. Cancer develops when the body’s normal control mechanism is compromised. In cancer,
old cells do not die, instead grow out of control forming new abnormal cells. These extra cells
may form a mass of tissue, called a tumor.

Cervical cancer on the other hand, is a malignant tumor of the cervix. This can be prevented
by PAP smear screening (Papanicolaou test) and a HPV vaccine (Human papilloma virus).
Cervical cancer is the most common type of cancer that affect women in Ghana. It develops
slowly . in the early stages, the changes are small. There are changes like rash called dysplasia
which do not cause any symptoms.

TYPES OF CERVICAL CANCER

Cancer is classified according to;

A. The type of cell involved:

1.Squamous cell carcinomas 2.Adenocarcinoma

1. Squamous cell carcinomas: these develop from cells in the exo-cervix. Squamous carcinomas
most often begin in the transformation zone (where the exo-cervix joins the endo-cervix). Most
cervical cancers are squamous cell carcinomas.

2.Adenocarcinomas: these are cancers that develop from glandular cells. Cervical
adenocarcinoma develop from the mucus-producing gland cells of the endo-cervix. Less
commonly, cervical cancers have features of cell carcinomas and adenocarcinomas. These are
called adenosquamous carcinomas or mixed carcinomas. This type of cervical cancer is less
common.

B. According to the degree of spread:

Carcinoma in situ(pre-invasive): cancer that has extended through the full thickness of
epithelium of the cervix, but not beyond Invasive cervical cancer

CAUSES

Changes in the cervix may come about as result of present of the human papilloma virus.
Chronic infection with certain HPV (type 16 and 18) may cause or lead to cervical cancer.

RISKFACTORS

1. Sexual contact with men whose partners have had cervical cancer
2. Family history of cervical cancer.
3. Multiple sex partners
4. Early age at first coitus, short interval between menarche and first coitus
5. Exposure to the human papillomavirus(HPV) type16 and 18
6. HIV infection and other causes of immunosuppression
7. Having sex with an uncircumcised male
8. Chronic cervical infection
9. Nutritional deficiencies(beta-carotene, vitamin C)
 CLINICAL FEATURES
Early stage cervical cancer generally produces no signs or symptoms, but in a
more advanced stage, there is vaginal bleeding after intercourse between periods
or after menopause
Watery bloody vaginal discharge that may be heavy and have foul odor
Pelvic pain or pain during intercourse
Pain during urination
Needing to urinate more often
Fatigue, weight loss, loss of appetite

DIAGNOSTIC INVESTIGATION
 Pap test- during a Pap test, the doctor gently scrapes the outside of the cervix and vagina,
taking samples of cells for testing.
 Biopsy-a biopsy is the removal of small amount of tissue for examination under a
microscope.
 Bimanual pelvic examination-insertion of 2 fingers of 1 hand inside the patent’s vagina
while the other hand presses on the lower abdomen to feel the uterus and ovaries.
 Colposcopy-an instrument called colposcope is used to magnify the cells of the cervix
and vagina, similar to a microscope. It gives the doctor alighted, magnified view of the
tissues of the vagina and the cervix
 Pelvic examination under anesthesia
 X- ray
 Computed tomography (CT scan)
 Magnetic resonance imaging (MRI)
 PAP SMEAR TEST
 COLPOSCOPY

PERI-OPERATIVE PREPARATION

 PSYCHOLOGICAL PREPARATION
 Establish rapport by creating a therapeutic relationship between patient and family.

Inform patient that pre-operative fear is normal and that it is not unusual to experience anxiety.
Reassure the patient or family of competency of surgeon and nursing staff.

Explain the nursing procedures involved in planning of surgery.

Assess patient knowledge of condition and surgery and reinforce patient teaching.

Allow patient to ask questions and provide explanation.

Encourage patient participation in decision making and care.

Allow the surgeon to explain the surgical experience the patient.

Explain all nursing care to patient, those that will cause discomfort and what will be done to
minimize it.

PSYCHOLOGICAL CARE

Encourage the man to provide support to the woman or serve as the woman’s support system

Provide counselling on how the cancer will affect their relationship

Present other means of meeting sexual desire such as oral sex, femoral sex, and masturbation

 PHYSIOLOGICAL PREPARATION

Assess patient nutrition and hydration status to prevent shock from dehydration.
Do laboratory tests and check x-ray to know any abnormalities of the thorax.

Administer prescribed IV fluids for hydration, nutrition and electrolyte balancing.

Monitor IV fluid on the fluid intake and output chart.

Administer prescribed medication.
Assess vital signs and record, report any abnormality.

 PHYSICAL PREPARATION
Let patient have thorough bath in the morning.
Remove all jewelries, watches, contact lenses etc.
Put on well labelled identification wristband.
Assess skin for abrasions, laceration or signs of infections at the operative site.

Prepare the skin by washing the site with soap and water, shave area and clean with antiseptic
lotion (savlon or povidone).

Pass urethral catheter.

Cover with sterile towel and hold it in place with adhesive tapes.
Change patient into theatre gown.

Maintain Nil Per Os 6-8hours before surgery.

Apply anti-embolic stocking.

 SOCIO-ECONOMIC PREPARATION

Inform patient on possible cost of surgery.

Enquire whether patient is on NHIS and provide necessary information.

Allow patient to pay deposit according to hospital protocol.
Encourage patient participation in the care.
Inform social welfare department if patient cannot pay his hospital bills.
Inform patient of the duration of stay in the hospital

 SPIRITUAL PREPARATION

Assist patient in using religious coping as it helps to reduce anxiety and fears.
Allow patient to receive spiritual support that she request for. The nurse support the religious
beliefs the patient by praying with her.

Respect patient’s cultural values as it facilitates rapport and trust between patient and nurse.

Restrict the intake of any concoction.

POST-OPERATIVECARE
Prepare operation bed with the necessary accessories

Quickly review postoperative instructions and receive patient

Monitor patient’s level of consciousness

Check the surgical site/incision site for bleeding
Reinforce if there is bleeding.
Notify the surgeon if bleeding persists
Observe and treat for shock(hypovolemia)

Monitor blood transfusion if in situ

Administer IV fluids as prescribed

Administer all post operative medications such as antibiotics, analgesics etc.

Maintain personal hygiene of the patient

Change wound dressing usually on the third day post operation using aseptic techniques
Provide education on discharge information covering areas such as medication, identification of
possible complications, review dates, nutrition, rest and sleep

COMPLICATIONS OF CERVICAL CANCER

Fistula formation; rectovaginal fistula, ureterovaginal fistula

Offensive vaginal discharge

Dysuria
Backpain

Leg pain

Vaginal bleeding
Abscesses in the ulcerating mass
Emaciation
Anemia

uremia
PREVENTION

Limiting the number of sex partners

Delaying first sexual intercourse until the late teens or older

Practicing safe sex by using condoms and dental dams

Avoiding sexual intercourse with people who have had many partners

MEDICAL MANAGEMENT

Conservative treatment may consist of monitoring through frequent Pap smears.

Chemotherapy
Radiotherapy
Surgery

SURGICAL INTERVENTIONS FOR CERVICAL CANCER

If you have cervical cancer, there are a number of ways your doctor can treat your condition.
Which one they recommend will depend on what type of cervical cancer you have, your age, and
whether or not you might want to have children in the future.

It will also depend on whether, or how far, the cancer has spread. Doctors call this the “stage” it
is in. The various surgeries include;

Cryosurgery

Your doctor uses a gas called liquid nitrogen to freeze the abnormal cancer cells on your cervix.
An “ice ball” forms, and the bad cells die. Your doctor can perform this procedure in their office
or clinic. You can go home after the procedure. You may have a watery discharge for a few
weeks. Cryosurgery is typically used during stage 0, which means your doctor has found
abnormal cells only on the surface of your cervix.
Laser Surgery

This is performed in your doctor’s office or clinic and is usually reserved for stage 0 cervical
cancer. Your doctor uses a laser beam to burn off the cancer cells on your cervix. They may also
cut a small piece of tissue to examine in a lab. They’ll numb your cervix so you won’t have any
pain.

Conization

A procedure in which a cone-shaped piece of abnormal tissue is removed from the cervix

This may be done before chemotherapy or radiation is recommended. If you want to be able to
have kids later, it may be the only treatment they recommend.Your doctor uses a surgical or laser
knife to remove a cone-shaped piece of tissue from your cervix. They may also use a thin wire
heated by electricity. This is called the loop electrosurgical excision procedure, or LEEP. They’ll
look at your tissue sample under a microscope. If the edges of the cone have cancer cells, some
of the cancer may have been left behind. Your doctor may then recommend chemo or radiation.

Hysterectomy

A hysterectomy is a surgical procedure done to remove the womb (uterus).

In this procedure, a surgeon removes your uterus and cervix. Your other reproductive organs --
your ovaries and fallopian tubes are left in place, unless there’s a medical reason they should be
removed, too.

Surgeons perform hysterectomies in one of three ways: through a cut in the abdomen (abdominal
hysterectomy); through the vagina (vaginal hysterectomy); or with the help of robotic
instruments (laparoscopic hysterectomy).

You’ll have to stay in the hospital after your surgery. With a laparoscopic or vaginal
hysterectomy, you’ll have a 1- or 2-day stay. Full recovery time is about 2 to 3 weeks.
After an abdominal hysterectomy, you’ll stay in the hospital for 3 to 5 days. Recovery time is
longer -- about 4 to 6 weeks.

Complications are rare, but can include excessive bleeding, infection, or damage to your urinary
system or intestines.

Radical Hysterectomy

This is a surgery done to remove the uterus, cervix, part of the vagina, and a wide area of
ligaments and tissues around these organs

During this surgery, the surgeon removes your uterus and the tissues next to it. They’ll also
remove about 1 inch of the vagina next to your cervix. And, they may take some of the lymph
nodes from your pelvic area. These are pockets of immune system tissue that are about the size
of a pea.

He’ll leave your ovaries and fallopian tubes, unless it’s medically necessary to take them, too.

Most of the time, this surgery is performed through your abdomen. But your doctor may be able
to use laparoscopy to remove your uterus through your vagina. This results in less blood loss,
and maybe a shorter hospital stay.

Full recovery time is 4 to 6 weeks.

Trachelectomy

This is a surgery done to remove the cervix.

If you still want to be able to have kids, your doctor may recommend a trachelectomy.
The surgeon removes your cervix and the top part of your vagina, but they leave your uterus
intact. They place a stitch, or a band, where your cervix had been. This opening leads to your
uterus.

They may also remove the lymph nodes near your cervix or uterus. They’ll perform this surgery
either through your vagina or through a cut in your abdomen.

The chance of your cancer coming back after this operation is very low. Studies show that
women who have a trachelectomy have a 50% chance of getting pregnant 5 years later. But they
also are at a higher risk of miscarriage than women who haven’t had this surgery.

Reference

www.cdc.gov.com

www.who.int

www.cancer.org

Group members

Mary Ampofo

Rebecca Naah

Millicent Owusu

Joyce Quartey

Kesty Owusu

Evangeline Baab Quaicoe

Matilda Amoh
Patricia Cogbe

Mariama Arthur

Elizabeth Taylor

Priscilla Quaicoe

Christabel Lily Thompson

Isabella Awere

Gloria Cobbinah

Christiana Quaicoe