CERVICAL CANCER

Is a common gynecologic malignancy.

Most commonly occurs in women age 35 to 55.

Major risk factors include early sexual activity, multiple sexual partners, and history of sexually
transmitted diseases especially human papilloma virus and herpes simplex virus.

Cervical cancer may involve the bladder, rectum, and may metastasize to the lungs,
mediastinum, bones, and liver.

Types of cervical cancer includes:

Dysplasia atypical cells with some degree of surface maturation.

Carcinoma in Situ (CIS) which is confined to the cervical epithelium.

Invasive carcinomas the stroma is involved, 90% are of the squamous cell type.

Invasive cancer spreads by local invasion and lymphatics to the vagina and beyond.
Assessment

1. Early disease is usually asymptomatic.

2. Initial symptoms are postcoital bleeding, irregular vaginal bleeding or spotting between periods
or after menopause, and malodorous discharge.
3. As disease progresses, bleeding becomes more constant and is accompanied by pain that
radiates to buttocks and legs.
4. Weight loss, anemia, and fever signal advance disease.
Diagnostic Evaluation
1. Papanicolaou (Pap) smear for cervical cytology is usual screening test. A computerized screening
program may increase the accuracy of manual laboratory Pap screening by as much as 30%.
2. If Pap test is abnormal, colposcopy, and biopsy or conization may be done.
3. Additional testing includes metastatic workup (chest x-ray, I.V. urogram, cystoscopy, barium
studies of colon and rectum, sigmoidoscopy)
Therapeutic Interventions
1. Intracavitary radiation for earlier localized stages radium by way of applicator in endocervical
canal.

2. External radiation for generalized pelvis effect in later stages.

3. Laser therapy may be used to treat dysplasia.
4. Chemotherapy may be used as adjuvant to surgery or radiation treatments.
Surgical Interventions
1. Conization is performed for micro-invasive stage if child-bearing is desired.
2. Cryosurgery, laser ablation, and loop electrosurgical excision procedure may be done for
dysplasia or CIS.
3. Hysterectomy, simple or radical depending on stage.
4. Pelvic exenteration for very advanced disease if radiation therapy cannot be used; also for
recurrent cancer.
Nursing Interventions
1. During intracavitary radiation, check radioisotope applicator position every 8 hours, and monitor
amount of bleeding and drainage (a small amount is normal).
2. Observe for signs and symptoms of radiation sickness such as nausea, vomiting, fever, diarrhea,
abdominal cramping.
3. Monitor for complications of surgery bleeding, infection.
4. Help the patient seek information on stage of cancer, treatment options.
5. Provide emotional support during treatment.
6. Advise patient to discharge after surgical procedures and need to report excessive, foulsmelling, discharge or bleeding.
7. Explain the importance of life-long follow up regardless of treatments to determine the
response to treatment and to detect spread of cancer.
8. Encourage all women to receive regular cervical cancer screening.
The HPV Vaccine
The human papilloma virus (HPV) vaccine prevents infection with certain serotypes of human papilloma
virus associated with the development of cervical cancer, genital warts, and some less common cancers.
The HPV vaccine is recommended for 11 and 12 year-old girls. It is also recommended for girls and
women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine
series.

BREAST CANCER

Is the leading type of cancer in women.Most breast cancer begins in the lining of the milk ducts,
sometimes the lobule.

The cancer grows through the wall of the duct and into the fatty tissue.

Breast cancer metastasizes most commonly to auxiliary nodes, lung, bone, liver, and the brain.

The most significant risk factors for breast cancer are gender (being a woman) and age (growing
older).

Other probable factors include nulliparity, first child after age 30, late menopause, early
menarche, long term estrogen replacement therapy, and benign breast disease.

Controversial risk factors include oral contraceptive use, alcohol use, obesity, and increased
dietary fat intake.

About 90% of breast cancers are due not to heredity, but to genetic abnormalities that happen
as a result of the aging process and life in general.

A womans risk of breast cancer approximately doubles if she has a first-degree relative (mother,
sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women
diagnosed with breast cancer have a family history of breast cancer.
STAGES OF BREAST CANCER

STAGE

DEFINITION

Stage 0

Cancer cells remain inside the breast duct, without invasion into
normal adjacent breast tissue.

Stage I

Cancer is 2 centimeters or less and is confined to the breast (lymph

nodes are clear).
No tumor can be found in the breast, but cancer cells are found in
the axillary lymph nodes (the lymph nodes under the arm)
OR

Stage IIA

the tumor measures 2 centimeters or smaller and has spread to the

axillary lymph nodes
OR
the tumor is larger than 2 but no larger than 5 centimeters and has
not spread to the axillary lymph nodes.
The tumor is larger than 2 but no larger than 5 centimeters and has
spread to the axillary lymph nodes

Stage IIB

OR
the tumor is larger than 5 centimeters but has not spread to the
axillary lymph nodes.
No tumor is found in the breast. Cancer is found in axillary lymph
nodes that are sticking together or to other structures, or cancer
may be found in lymph nodes near the breastbone

Stage IIIA

OR
the tumor is any size. Cancer has spread to the axillary lymph
nodes, which are sticking together or to other structures, or cancer
may be found in lymph nodes near the breastbone.

Stage IIIB

The tumor may be any size and has spread to the chest wall and/or

skin of the breast

AND
may have spread to axillary lymph nodes that are clumped together
or sticking to other structures, or cancer may have spread to lymph
nodes near the breastbone.
Inflammatory breast cancer is considered at least stage IIIB.
There may either be no sign of cancer in the breast or a tumor may
be any size and may have spread to the chest wall and/or the skin
of thebreast
AND
Stage IIIC

the cancer has spread to lymph nodes either above or below the
collarbone
AND
the cancer may have spread to axillary lymph nodes or to lymph
nodes near the breastbone.

Stage IV

The cancer has spread or metastasized to other parts of the

body.
ASSESSMENT

A firm lump or thickness in breast, usually painless; 50% are located in the upper outer quadrant
of the breast.

Spontaneous nipple discharge; may be bloody, clear or serous.

Asymmetry of the breast may be noted as the woman changes positions; compare
one breast with the other.

Nipple retraction or scalliness, especially in Pagets disease.

Enlargement of auxiliary or supraclavicular lymph nodes may indicate metastasis.

DIAGNOSTIC EVALUATION

Mammography (most accurate method of detecting non-palpable lesions) shows lesions and
cancerous changes, such as microcalcification. Ultrasonography may be used to distinguish cysts
from solid masses.

Biopsy or aspiration confirms diagnosis and determines the type ofbreast cancer.

Estrogen or progesterone receptor assays, proliferation or S phase study (tumor aggressive), and
other test of tumor cells determine appropriate treatment and prognosis.

Blood testing detects metastasis; this includes liver function tests to detect liver metastasis and
calcium and alkaline phosphatase levels to detect bony metastasis.

Chest x-rays, bone scans, or possible brain and chest CT scans detect matastasis.
PHARMACOLOGIC INTERVENTIONS

1. Chemotherapy is the primary used as adjuvant treatment postoperatively; usually begins 4

weeks after surgery (very stressful for a patient who just finished major surgery).

Treatments are given every 3 to 4 weeks for 6 to 9 months. Because the drugs differ in
their mechanisms of action, various combinations are used to treat cancer.

Principal breast cancer drugs include cyclophosphamides, methotrexate, fluorouracil,

doxorubicin, and paclitaxel.

Additional agents for advanced breast cancer include docetaxel, vinorelbine,

mitoxantrone, and fluorouracil.

Herceptin is a monoclonal antibody directed against Her-2/neu oncogene; may be

effective for patients who express this gene

2. Indications for chemotherapy include large tumors, positive lymph nodes, premenopausal
women, and poor prognostic factors.
3. Chemotherapy is also used as primary treatment in inflammatory breast cancer and as palliative
treatment in metastatic disease or recurrence.
4. Anti-estrogens, such as tamoxifen, are used as adjuvant systemic therapy after surgery.
5. Hormonal agents may be used in advanced disease to induce remissions that last for months to
several years.
SURGICAL INTERVENTIONS
1. Surgeries include lumpectomy (breast-preventing procedure), mastectomy (breast removal),
and mammoplasty (reconstructive surgery).
2. Endocrine related surgeries to reduce endogenous estrogen as a palliative measure.
3. Bone marrow transplantation may be combined with chemotherapy.

NURSING INTERVENTIONS
1. Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea,
anorexia.
2. Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting,
alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression.
3. Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. Provide
psychological support to the patient throughout the diagnostic and treatment process.
4. Involve the patient in planning and treatment.
5. Describe surgical procedures to alleviate fear.
6. Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue.
7. Administer antiemetic prophylactically, as directed, for patients receiving chemotherapy.
8. Administer I.V. fluids and hyper alimentation as indicated.
9. Help patient identify and use support persons or family or community.
10. Suggest to the patient the psychological interventions may be necessary for anxiety, depression,
or sexual problems.
11. Teach all women the recommended cancer-screening procedures.