Cervical cancer is malignant neoplasm of the cervix uteri or cervical area.

It may present with vaginal

bleeding, but symptoms may be absent until the cancer is in its advanced stages.[1] Treatment consists
of surgery (including local excision) in early stages and chemotherapy and radiotherapy in advanced
stages of the disease.

Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes
can prevent the development of cancer. In developed countries, the widespread use of cervical screening
programs has reduced the incidence of invasive cervical cancer by 50% or more.[citation needed]

Human papillomavirus (HPV) infection is a necessary factor in the development of almost all cases of
cervical cancer.[1][2] HPV vaccines effective against the two strains of HPV that currently cause
approximately 70% of cervical cancer have been licensed in the U.S, Canada, Australia and the EU.[3]
[4]
Since the vaccines only cover some of the cancer causing ("high-risk") types of HPV, women should
seek regular Pap smear screening, even after vaccination.[5]

ANATOMY

The cervix is the narrow portion of the uterus where it joins with the top of the vagina. Most cervical
cancers are squamous cell carcinomas, arising in thesquamous (flattened) epithelial cells that line the
cervix. Adenocarcinoma, arising in glandular epithelial cells is the second most common type. Very rarely,
cancer can arise in other types of cells in the cervix.
Signs and symptoms

The early stages of cervical cancer may be completely asymptomatic.[1][6] Vaginal bleeding, contact
bleeding or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during
sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced
disease,metastases may be present in the abdomen, lungs or elsewhere.

Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain,
back pain, leg pain, single swollen leg, heavy bleeding from the vagina, leaking of urine or faeces from
the vagina,[7] and bone fractures.

PADAGDAGAN!!!!!!!!!!!!!!!!!!!!!!

CAUSES
Human papillomavirus (HPV) infection with high-risk types has been shown to be a necessary factor in
the development of cervical cancer.[8] HPV DNA may be detected in virtually all cases of cervical cancer.[1]
[8][2]
Not all of the causes of cervical cancer are known. Several other contributing factors have been
implicated.[9]

Human papillomavirus infection

In the United States each year there are more than 6.2 million new HPV infections in both men and
women, according to the CDC, of which 10 percent will go on to develop persistent dysplasia or cervical
cancer. That is why HPV is known as the "common cold" of the sexually transmitted infection world. It is
very common and affects roughly 80 percent of all sexually active people, whether they have symptoms
or not. The most important risk factor in the development of cervical cancer is infection with a high-risk
strain of human papillomavirus. The virus cancer link works by triggering alterations in the cells of the
cervix, which can lead to the development of cervical intraepithelial neoplasia, which can lead to cancer.

Women who have many sexual partners (or who have sex with men who had many other partners) have
a greater risk.[10][11]

More than 150 types of HPV are acknowledged to exist (some sources indicate more than 200 subtypes).
[12][13]
Of these, 15 are classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73,
and 82), 3 as probable high-risk (26, 53, and 66), and 12 as low-risk (6, 11, 40, 42, 43, 44, 54, 61, 70, 72,
81, and CP6108).[14] Types 16 and 18 are generally acknowledged to cause about 70% of cervical cancer
cases. Together with type 31, they are the prime risk factors for cervical cancer.[15]

Genital warts are caused by various strains of HPV which are usually not related to cervical cancer.
However, it is possible to have multiple strains at the same time, including those that can cause cervical
cancer along with those that cause warts. The medically accepted paradigm, officially endorsed by the
American Cancer Society and other organizations, is that a patient must have been infected with HPV to
develop cervical cancer, and is hence viewed as asexually transmitted disease, but most women infected
with high risk HPV will not develop cervical cancer.[16] Use of condoms reduces, but does not always
prevent transmission. Likewise, HPV can be transmitted by skin-to-skin-contact with infected areas. In
males, there is no commercially available test for HPV, although HPV is thought to grow preferentially in
the epithelium of the glans penis, and cleaning of this area may be preventative.[

Cofactors
The American Cancer Society provides the following list of risk factors for cervical cancer: human
papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, stress and stress-related
disorders, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal
drug diethylstilbestrol (DES)(medicine)|family history]] of cervical cancer.[10] There is a possible genetic
risk associated with HLA-B7.[citation needed]

There has not been any definitive evidence to support the claim that circumcision of the male partner
reduces the risk of cervical cancer, although some researchers say there is compelling epidemiological
evidence that men who have been circumcised are less likely to be infected with HPV.[17] However, in men
with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to
the risk of cervical cancer.[18]
Diagnosis
[edit]Biopsy procedures
While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-
cancer requires a biopsy of the cervix. This is often done through colposcopy, a magnified visual
inspection of the cervix aided by using a dilute acetic acid (e.g. vinegar) solution to highlight abnormal
cells on the surface of the cervix.[1]

Colposcopic impression, the estimate of disease severity based on the visual inspection, forms part of the
diagnosis.

Further diagnostic and treatment procedures are loop electrical excision procedure (LEEP)
and conization, in which the inner lining of the cervix is removed to be examined pathologically. These are
carried out if the biopsy confirms severe cervical intraepithelial neoplasia.

[edit]Pathologic types

This large squamous carcinoma (bottom of picture) has obliterated the cervix and invaded the lower uterine segment. The
uterus also has a round leiomyoma up higher.
Micrograph of a (cervical) adenosquamous carcinoma, a type of cervical cancer. H&E stain.

[edit]Potentially precancerous lesions

Cervical intraepithelial neoplasia, the potential precursor to cervical cancer, is often diagnosed on
examination of cervical biopsies by a pathologist. For premalignant dysplastic changes, the CIN (cervical
intraepithelial neoplasia) grading is used.

The naming and histologic classification of cervical carcinoma percursor lesions has changed many times
over the 20th century. The World Health Organization classification[19][20] system was descriptive of the
lesions, naming them mild, moderate or severe dysplasia or carcinoma in situ (CIS). The term,Cervical
Intraepithelial Neoplasia (CIN) was developed to place emphasis on the spectrum of abnormality in these
lesions, and to help standardise treatment.[20] It classifies mild dysplasia as CIN1, moderate dysplasia as
CIN2, and severe dysplasia and CIS as CIN3. More recently, CIN2 and CIN3 have been combined into
CIN2/3. These results are what a pathologist might report from a biopsy.

These should not be confused with the Bethesda System terms for Pap smear (cytology) results. Among
the Bethesda results: Low-grade Squamous Intraepithelial Lesion (LSIL) and High-grade Squamous
Intraepithelial Lesion (HSIL). An LSIL Pap may correspond to CIN1, and HSIL may correspond to CIN2
and CIN3,[20] however they are results of different tests, and the Pap smear results need not match the
histologic findings.
[edit]Cancer subtypes

Histologic subtypes of invasive cervical carcinoma include the following:[21][22] Though squamous cell
carcinoma is the cervical cancer with the most incidence, the incidence of adenocarcinoma of the cervix
has been increasing in recent decades.[1]

 squamous cell carcinoma (about 80-85%[citation needed])

 adenocarcinoma (about 15% of cervical cancers in the UK[19])
 adenosquamous carcinoma
 small cell carcinoma
  neuroendocrine carcinoma

Non-carcinoma malignancies which can rarely occur in the cervix include

 melanoma
 lymphoma

Note that the FIGO stage does not incorporate lymph node involvement in contrast to the TNM staging for
most other cancers.

For cases treated surgically, information obtained from the pathologist can be used in assigning a
separate pathologic stage but is not to replace the original clinical stage.

[edit]Staging

Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging
system, which is based on clinical examination, rather than surgical findings. It allows only the following
diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy,
endocervical curettage, hysteroscopy, cystoscopy,proctoscopy, intravenous urography, and X-
ray examination of the lungs and skeleton, and cervical conization.

The TNM staging system for cervical cancer is analogous to the FIGO stage.

 Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma
in situ)
 Stage I - limited to the cervix
 IA - diagnosed only by microscopy; no visible lesions
 IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal
spread
 IA2 - stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or
less
 IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal
spread of more than 7 mm
 IB1 - visible lesion 4 cm or less in greatest dimension
 IB2 - visible lesion more than 4 cm
 Stage II - invades beyond cervix
 IIA - without parametrial invasion, but involve upper 2/3 of vagina
 IIB - with parametrial invasion
  Stage III - extends to pelvic wall or lower third of the vagina
 IIIA - involves lower third of vagina
 IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney
 Stage IV - extends outside the vagina
 IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis
 IVB - distant metastasis

Stage 1-A1 young women - conizationwis clear margin. Parous women - hysterectomy.

Stage 1-A2 laproscopic lymphadenectomy + vaginal trechelectomy + post operative radiotherapy.

Stage 1B & 2A 1. Wertheim's hysterectomy . 2- schauta vaginal hysterectomy + laparoscopic

lymphadenectomy 3: primary radiotherapy 4: combined surgery & radiotherapy.

Stage 2B , 3 , 4 - chemotherapy

[edit]Prevention

[edit]Primary Prevention
[edit]Vaccination
Main article: HPV vaccine

Gardasil, licensed and manufactured by Merck & Co. is a vaccine against HPV types 6, 11, 16 & 18.
Gardasil is up to 98% effective.[23] It received approval from the US Food and Drug Administration on June
8, 2006.[3] Gardasil has also been approved in the EU.[24]

Cervarix, manufactured by GlaxoSmithKline, has been shown to be 92% effective in preventing HPV
strains 16 and 18 and is effective for more than four years.[25] Cervarix was approved in the US on 16
October 2009,[26] and in the EU in September 2007, as well as other nations.[27][28]

Neither Merck & Co. nor GlaxoSmithKline invented the vaccine. The vaccine's key developmental steps
are claimed by the National Cancer Institute in the US, the University of Rochester in New
York,Georgetown University in Washington, DC, Dartmouth College in Hanover, NH, and the University of
Queensland in Brisbane, Australia. Both Merck & Co. and GlaxoSmithKline have licensed patents from all
of these parties.[29]
Together, HPV types 16 and 18 currently cause about 70% of cervical cancer cases. HPV types 6 and 11
cause about 90% of genital wart cases. HPV vaccines have also been shown to prevent precursors to
some other cancers associated with HPV.[30][31]

HPV vaccines are targeted at girls and women of age 9 to 26 because the vaccine only works if given
before infection occurs; therefore, public health workers are targeting girls before they begin having sex.
The vaccines have been shown to be effective for at least 4[5] to 6[32] years, and it is believed they will be
effective for longer,[33] however the duration of effectiveness and whether a booster will be needed is
unknown.

The use of the vaccine in men to prevent genital warts, anal cancer, and interrupt transmission to women
or other men is initially considered only a secondary market.

The high cost of this vaccine has been a cause for concern. Several countries have or are considering
programs to fund HPV vaccination.
[edit]Condoms

Condoms offer some protection against cervical cancer.[34] Evidence on whether condoms protect against
HPV infection is mixed, but they may protect against genital warts and the precursors to cervical cancer.
[34]
They also provide protection against other STDs, such as HIV and Chlamydia, which are associated
with greater risks of developing cervical cancer.

Condoms may also be useful in treating potentially precancerous changes in the cervix. Exposure to
semen appears to increase the risk of precancerous changes (CIN 3), and use of condoms helps to
cause these changes to regress and helps clear HPV.[35] One study suggests
that prostaglandin in semen may fuel the growth of cervical and uterine tumours and that affected women
may benefit from the use of condoms.[36][37]
[edit]Smoking avoidance
Main article: Smoking cessation

Carcinogens from tobacco increase the risk for many cancer types, including cervical cancer, and women
who smoke have about double the chance of a nonsmoker to develop cervical cancer.[38][39]
[edit]Nutrition
Fruits and vegetables

Higher levels of vegetable consumption were associated with a 54% decrease risk of HPV persistence.
[40]
Consumption of papaya at least once a week was inversely associated with persistent HPV infection.[41]

Vitamin A
There is weak evidence to suggest a significant deficiency of retinol can increase chances of cervical
dysplasia, independently of HPV infection. A small (n~=500) case-control study of a narrow ethnic group
(native Americans in New Mexico) assessed serum micro-nutrients as risk factors for cervical dysplasia.
Subjects in the lowest serum retinol quartile were at increased risk of CIN I compared with women in the
highest quartile.[42]

However, the study population had low overall serum retinol, suggesting deficiency. A study of serum
retinol in a well-nourished population reveals that the bottom 20% had serum retinol close to that of the
highest levels in this New Mexico sub-population.[43]

Vitamin C

Risk of type-specific, persistent HPV infection was lower among women reporting intake values of vitamin
C in the upper quartile compared with those reporting intake in the lowest quartile.[41]

Vitamin E

HPV clearance time was significantly shorter among women with the highest compared with the lowest
serum levels of tocopherols, but significant trends in these associations were limited to infections lasting
</=120 days. Clearance of persistent HPV infection (lasting >120 days) was not significantly associated
with circulating levels of tocopherols. Results from this investigation support an association of
micronutrients with the rapid clearance of incident oncogenic HPV infection of the uterine cervix.[44]

A statistically significantly lower level of alpha-tocopherol was observed in the blood serum of HPV-
positive patients with cervical intraepithelial neoplasia. The risk of dysplasia was four times higher for an
alpha-tocopherol level < 7.95 mumol/l.[45]

Folic acid

Higher folate status was inversely associated with becoming HPV test-positive. Women with higher folate
status were significantly less likely to be repeatedly HPV test-positive and more likely to become test-
negative. Studies have shown that lower levels of antioxidants coexisting with low levels of folic acid
increases the risk of CIN development. Improving folate status in subjects at risk of getting infected or
already infected with high-risk HPV may have a beneficial impact in the prevention of cervical cancer.[46][47]

However, another study showed no relationship between folate status and cervical dysplasia.[42]

Carotenoids

Higher circulating levels of carotenoids were associated with a significant decrease in the clearance time
of type-specific HPV infection, particularly during the early stages of infection (</=120 days). Clearance of
persistent HPV infection (lasting >120 days) was not significantly associated with circulating levels of
carotenoids.[44]
The likelihood of clearing an oncogenic HPV infection is significantly higher with increasing levels
of lycopenes.[48] A 56% reduction in HPV persistence risk was observed in women with the highest
plasma [lycopene] concentrations compared with women with the lowest plasma lycopene concentrations.
These data suggests that vegetable consumption and circulating lycopene may be protective against HPV
persistence.[40][41][49]

CoQ10

Women who had either CIN or cervical cancer had markedly lower levels of CoQ10 in their blood and in
their cervical cells than the women who were healthy.[citation needed]

[edit]Secondary Prevention
[edit]Awareness

According to the US National Cancer Institute's 2005 Health Information National Trends survey, only
40% of American women surveyed had heard of human papillomavirus (HPV) infection and only 20% had
heard of its link to cervical cancer.[50]
[edit]Screening
Main article: Pap test

The widespread introduction of the Papanicolaou test, or Pap smear for cervical cancer screening has
been credited with dramatically reducing the incidence and mortality of cervical cancer in developed
countries.[6] Pap smear screening every 3–5 years with appropriate follow-up can reduce cervical cancer
incidence by up to 80%.[51] Abnormal Pap smear results may suggest the presence of cervical
intraepithelial neoplasia (potentially premalignant changes in the cervix) before a cancer has developed,
allowing examination and possible preventive treatment. If premalignant disease or cervical cancer is
detected early, it can be monitored or treated relatively noninvasively, with little impairment of fertility.

Cervical cancer screening is typically recommended starting three years or more after first sex, or starting
at age 21 to 25.[52][53][citation needed] Recommendations for how often a Pap smear should be done vary from
once a year to once every five years, in the absence of abnormal results.[51] Guidelines vary on how long
to continue screening, but well screened women who have not had abnormal smears can stop screening
about age 60 to 70.[52][53][54]

To take a Pap smear, the vagina is held open with a speculum, the loose surface cells on the cervix are
scraped using a specially shaped spatula and a brush, and the cells are spread on a microscope slide. At
a laboratory the slide is stained, examined for abnormal cells and findings are reported.

Until recently the Pap smear has remained the principal technology for preventing cervical cancer.
However, following a rapid review of the published literature, originally commissioned by NICE,[55] liquid
based cytology has been incorporated within the UK national screening programme. Although it was
probably intended to improve on the accuracy of the Pap test, its main advantage has been to reduce the
number of inadequate smears from around 9% to around 1%.[56] This reduces the need to recall women
for a further smear.

Automated technologies have been developed with the aim of improving on the interpretation of smears,
normally carried out by cytotechnologists. Unfortunately these on the whole have proven less useful;
although the more recent reviews suggest that generally they may be no worse than human
interpretation.[57]

The HPV test is a newer technique for cervical cancer triage which detects the presence of human
papillomavirus infection in the cervix. It is more sensitive than the pap smear (less likely to produce false
negative results), but less specific (more likely to produce false positive results) and its role in routine
screening is still evolving. Since more than 99% of invasive cervical cancers worldwide contain HPV,
some researchers recommend that HPV testing be done together with routine cervical screening.[15] But,
given the prevalence of HPV (around 80% infection history among the sexually active population) others
suggest that routine HPV testing would cause undue alarm to carriers, more unnecessary follow-up
testing and treatment. HPV testing along with cytology significantly increases the cost of screening.

Various experimental techniques, such as visual inspection using acetic acid, sometimes with special
lights (speculoscopy), or taking pictures for expert evaluation (cervicography) have been evaluated as
adjuncts to or replacements for Pap smear screening, especially in countries where Pap smear screening
is prohibatively expensive. There are efforts to develop low cost HPV tests which might be used for
primary screening of older women in less developed countries.

[edit]Treatment

Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including
part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who
desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure (LEEP)
or cone biopsy.[58]

If a cone biopsy does not produce clear margins,[59] one more possible treatment option for patients who
want to preserve their fertility is a trachelectomy.[60] This attempts to surgically remove the cancer while
preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is
a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered
a standard of care,[61] as few doctors are skilled in this procedure. Even the most experienced surgeon
cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as
the extent of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear
margins of cervical tissue once the patient is under general anesthesia in the operating room, a
hysterectomy may still be needed. This can only be done during the same operation if the patient has
given prior consent. Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and
some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the uterus
for pathologic evaluation.

A radical trachelectomy can be performed abdominally[62] or vaginally[63] and there are conflicting opinions
as to which is better.[64] A radical abdominal trachelectomy with lymphadenectomy usually only requires a
two to three day hospital stay, and most women recover very quickly (approximately six weeks).
Complications are uncommon, although women who are able to conceive after surgery are susceptible to
preterm labor and possible late miscarriage.[65] It is generally recommended to wait at least one year
before attempting to become pregnant after surgery.[66] Recurrence in the residual cervix is very rare if the
cancer has been cleared with the trachelectomy.[61] Yet, it is recommended for patients to practice vigilant
prevention and follow up care including pap screenings/colposcopy, with biopsies of the remaining lower
uterine segment as needed (every 3–4 months for at least 5 years) to monitor for any recurrence in
addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to
conceive.

Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the
lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis
and brachytherapy (internal radiation). Patients treated with surgery who have high risk features found on
pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the
risk of relapse.

Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy
and cisplatin-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation
therapy), or cisplatin chemotherapy followed by hysterectomy.

Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy.

On June 15, 2006, the US Food and Drug Administration approved the use of a combination of two
chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical cancer treatment.
[67]
Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects.
Hycamtin is manufactured by GlaxoSmithKline.

[edit]Prognosis

Prognosis depends on the stage of the cancer. With treatment, the 5-year relative survival rate for the
earliest stage of invasive cervical cancer is 92%, and the overall (all stages combined) 5-year survival
rate is about 72%. These statistics may be improved when applied to women newly diagnosed, bearing in
mind that these outcomes may be partly based on the state of treatment five years ago when the women
studied were first diagnosed.[68]

With treatment, 80 to 90% of women with stage I cancer and 50 to 65% of those with stage II cancer are
alive 5 years after diagnosis. Only 25 to 35% of women with stage III cancer and 15% or fewer of those
with stage IV cancer are alive after 5 years.[69]

According to the International Federation of Gynecology and Obstetrics, survival improves when
radiotherapy is combined with cisplatin-based chemotherapy.[70]

As the cancer metastasizes to other parts of the body, prognosis drops dramatically because treatment of
local lesions is generally more effective than whole body treatments such as chemotherapy.

Interval evaluation of the patient after therapy is imperative. Recurrent cervical cancer detected at its
earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination of
the three. Thirty-five percent of patients with invasive cervical cancer have persistent or recurrent disease
after treatment.[71]

Average years of potential life lost from cervical cancer are 25.3 (SEER Cancer Statistics Review 1975-
2000, National Cancer Institute (NCI)). Approximately 4,600 women were projected to die in 2001 in the
US of cervical cancer (DSTD), and the annual incidence was 13,000 in 2002 in the US, as calculated by
SEER. Thus the ratio of deaths to incidence is approximately 35.4%.

Regular screening has meant that pre cancerous changes and early stage cervical cancers have been
detected and treated early. Figures suggest that cervical screening is saving 5,000 lives each year in the
UK by preventing cervical cancer.[72] About 1,000 women per year die of cervical cancer in the UK.

Epidemiology
Worldwide, cervical cancer is twelfth most common[74] and the fifth most deadly cancer in women.[75] It
affects about 16 per 100,000 women per year and kills about 9 per 100,000 per year.[76] Approximately
80% of cervical cancers occur in developing countries[77] Worldwide, in 2008, it was estimated that there
were 473,000 cases of cervical cancer, and 253,500 deaths per year.[78]

In the United States, it is only the 8th most common cancer of women. In 1998, about 12,800 women
were diagnosed in the US and about 4,800 died.[6] In 2008 in the US an estimated 11,000 new cases
were expected to be diagnosed, and about 3,870 were expected to die of cervical cancer.[68] Among
gynecological cancers it ranks behind endometrial cancer and ovarian cancer. The incidence and
mortality in the US are about half those for the rest of the world, which is due in part to the success of
screening with the Pap smear.[6] The incidence of new cases of cervical cancer in the United States was 7
per 100,000 women in 2004.[79] Cervical cancer deaths decreased by approximately 74% in the last 50
years, largely due to widespread Pap smear screening.[74]The annual direct medical cost of cervical
cancer prevention and treatment is prior to introduction of the HPV vaccine was estimated at $6 billion.[74]

In the European Union, there were about 34,000 new cases per year and over 16,000 deaths due to
cervical cancer in 2004.[51]

In the United Kingdom, the age-standardised (European) incidence is 8.5/100,000 per year (2006). It is
the twelfth most common cancer in women, accounting for 2% of all female cancers, and is the second
most common cancer in the under 35s females, after breast cancer. The UK's European age-
standardised mortality is 2.4/100,000 per year (2007) (Cancer Research UK Cervical cancer statistics for
the UK).[80] With a 42% reduction from 1988-1997 the NHS implemented screening programme has been
highly successful, screening the highest risk age group (25–49 years) every 3 years, and those ages 50–
64 every 5 years.

In Canada, an estimated 1,300 women will be diagnosed with cervical cancer in 2008 and 380 will die.[81]

In Australia, there were 734 cases of cervical cancer (2005). The number of women diagnosed with
cervical cancer has dropped on average by 4.5% each year since organised screening began in 1991
(1991–2005).[82] Regular two-yearly Pap tests can reduce the incidence of cervical cancer by up to 90% in
Australia, and save 1,200 Australian women dying from the disease each year.[83]

SURGERY (surgical procedures for cervical cancer)

 Total hysterectomy – removal of uterus, cervix, and ovaries

 Radical hysterectomy –

Surgical Options for Cervical Cancer

The following surgical procedures may be used as part of cervical cancer treatment.

Conization

Conization, also called a cone biopsy, is a procedure that is used to remove a cone-shaped
piece of tissue from the cervix and cervical canal. A pathologist will view the tissue under a
microscope to look for cancer cells. This type of surgery may be used to diagnose or treat a
cervical condition.
Total Hysterectomy

A total hysterectomy is a surgical procedure that is used to remove the uterus, including the
cervix. Three different procedures may be used to perform a total hysterectomy:

• A vaginal hysterectomy, in which the uterus and cervix are taken out
through the vagina

• A total abdominal hysterectomy, in which the uterus and cervix are taken
out through a large incision (cut) in the abdomen (stomach)

• A total laparoscopic hysterectomy, in which the uterus and cervix are

taken out through a small incision in the abdomen using a laparoscope.

Bilateral Salpingo-Oophorectomy (BSO)

A BSO is a surgical procedure that is used to remove the ovaries and the fallopian tubes.

Radical Hysterectomy

A radical hysterectomy is a surgical procedure that is used to remove the uterus, cervix,
and part of the vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be
removed.

Pelvic Exenteration

A pelvic exenteration is a surgical procedure that is used to remove the lower colon,
rectum, and bladder. For women, the cervix, vagina, ovaries, and nearby lymph nodes are
also removed. Surgeons will need to make artificial openings (stomas) for the urine and the
stool. Women may need plastic surgery to make an artificial vagina after they have had a
pelvic exenteration.

Cryosurgery
Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue,
such as carcinoma in situ. This type of cervical cancersurgery is also called cryotherapy.

Laser Surgery

Laser surgery is a procedure that uses a laser beam (a narrow beam of intense light) as a
knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

Loop Electrosurgical Excision Procedure (LEEP)

LEEP is a treatment that uses electrical current (passed through a thin wire loop) as a knife
to remove abnormal tissue or cancer.

Recovering From Cervical Cancer Surgery

It takes time to heal after surgery for cervical cancer, and the recovery time is different for
each woman. If you had surgery to remove a small tumor on the surface of the cervix, you
may experience cramping, pain, bleeding, or a watery discharge.

If you had a hysterectomy, the length of the hospital stay may vary from several days to a
week. Common discomforts after a hysterectomy include:

• Feeling tired or weak

• Nausea and vomiting
• Bladder and bowel problems.

After cervical cancer surgery, your doctor may restrict your diet to liquids at first, with a
gradual return to solid food. However, most women return to their normal activities within
four to eight weeks after surgery.

After a hysterectomy, women will no longer have menstrual periods, and they will not be
able to become pregnant. When the ovaries are removed, menopause will occur at
once. Symptoms of menopausethat are caused by cervical surgery may be more severe
than those caused by natural menopause. Some drugs have been shown to help women
with these symptoms, and may be more effective if they are started before surgery for
cervical cancer.
After surgery, some women may be concerned about sexual intimacy. Many women find
that it helps to share these concerns with their partner or a counselor.

Nursing Assessment Nursing care plans for Cervical Cancer

Patient’s history, early cervical cancer usually asymptomatic, establishes a thorough history with particular attention
to the presence of the risk factors and the woman’s menstrual history. assess a history of later symptoms of cervical
cancer, including abnormal bleeding or spotting between periods or after menopause, metrorrhagia or menorrhagia,
dysparuenia and postcoital bleeding; leukorrhea in increasing amounts and changing over time from watery to dark
and foul; and a history of chronic cervical infections. Determine if the patient has experienced weight gain or loss;
abdominal or pelvic pain, often unilateral, radiating to the buttocks and legs, or other symptoms associated with
neoplasms, such as fatigue. The patient history includes abnormal vaginal bleeding, such as a persistent vaginal
discharge that may be yellowish, blood-tinged, and foul-smelling; postcoital pain and bleeding; and bleeding between
menstrual periods or unusually heavy menstrual periods. The patient history may suggest one or more of the
predisposing factors for this disease.
Physical Examination.Pelvic examination. Observe the patient’s external genitalia for signs of inflammation,
bleeding, discharge, or local skin or epithelial changes.
Palpate for motion tenderness of the cervix (Chandelier’s sign); a positive Chandelier’s sign (pain on movement)
usually indicates an infection. Also examine the size, consistency (hardness may reflect invasion by neoplasm),
shape, mobility (cervix should be freely movable), tenderness, and presence of masses of the uterus and adnexa.
If the cancer has advanced into the pelvic wall, the patient may report gradually increasing flank pain, which can
indicate sciatic nerve involvement. Leakage of urine may point to metastasis into the bladder with formation of a
fistula. Leakage of stool may indicate metastasis to the rectum with fistula development.
Diagnostic test for Cervical Cancer
• Papanicolaou examination ((Pap smear)
• Colposcopy followed by punch biopsy or cone biopsy
• The Vira/Pap test to examination of the specimen’s deoxyribonucleic acid (DNA) structure to detect HPV
Nursing diagnosis nursing care plans for Cervical Cancer
Common nursing diagnosis found in nursing care plans for Cervical Cancer:
• Pain (acute) related to postprocedure swelling and nerve damage
• Anxiety
• Fear
• Impaired physical mobility
• Impaired skin integrity
• Ineffective coping
• Ineffective sexuality patterns
• Risk for infection
• Sexual dysfunction
Related posts:
1. Cervical Cancer
2. Nursing care plans for Cervical Cancer
3. Patient Teaching for Cervical Cancer
4. Nursing Diagnosis For Breast Cancer
5. Nursing Diagnosis For Bladder Cancer
Patient teaching, discharge and home healthcare guidelines for patients
with Cervical Cancer:
Be sure the patient and family understand any pain medication prescribed, including dosage, route, action, and side
effects. Reassure the patient that this disease and Cervical Cancer care treatment should not radically alter her
lifestyle or prohibit sexual intimacy. Tell to the patient all the post procedure complications. Ensure that the patient
understands the need for ongoing Pap smears if appropriate. Vaginal cytological studies are recommended at 4-
month intervals for 2 years, every 6 months for 3 years, and then annually. Explain the importance of complying with
follow-up visits to the gynecologist and oncologist. Stress the value of these visits in detecting disease progression or
recurrence
Biopsy
Explain to the patient that she may feel pressure, minor abdominal cramps, or a pinch from the punch forceps.
Reassure her that the pain will be minimal because the cervix has few nerve endings.
Cryosurgery
Explain to the patient that the procedure takes about 15 minutes, during which time the physician uses refrigerant to
freeze the cervix. Caution to the patients that she may experience abdominal cramps, headache, and sweating, but
reassure her that she will feel little, if any, pain.
Laser surgery
Explain to the patient the laser surgery procedure takes about 30 minutes and may cause abdominal cramps. After
excision biopsy, cryosurgery, or laser therapy, tell the patient to expect a discharge or spotting for about 1 week.
Advise her not to douche, use tampons, or engage in sexual intercourse during this time. Caution her to report signs
of infection. Stress the need for a follow-up Pap test and a pelvic examination in 3 to 4 months and periodically
thereafter. Also, tell her what to expect postoperatively if a hysterectomy is necessary.
Preloaded internal radiation therapy
Tell to the patient that preloaded internal radiation therapy procedure requires hospital stay, bowel preparation, a
povidoneiodine vaginal douche, a clear liquid diet, and nothing by mouth the night before the implantation. It also
requires an indwelling urinary catheter. Inform the patient that preloaded internal radiation therapy is performed in the
operating room under general anesthesia.
After loaded internal radiation therapy
Explain to the patient that a member of the radiation team implants the source after the patient returns to her room
from surgery. Remind the patient to watch for and report uncomfortable adverse effects, warn the patient to avoid
people with obvious infections during therapy. Inform the patient that vaginal narrowing caused by scar tissue can
occur after internal radiation. Describe the complications that can occur after high-dose radiation therapy.
Related posts:
1. Patient Teaching and Home Health Guidance for Bladder Cancer
2. Nursing care plans for Cervical Cancer
3. Patient Teaching, Discharge And Home Healthcare Guidelines for patient with Lung Cancer
4. Patient Teaching and Home Healthcare Guidelines for Breast Cancer
5. Patient teaching for Pneumothorax