dna tumor virus associated with premalignant/malignant cervical disease and other cancers over 100...
TRANSCRIPT
![Page 1: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/1.jpg)
Chapter 06Promoting Reproductive Health Through an Understanding
of Cervical Cytology Screening, Human Papillomavirus, and
Cervical Cancer
![Page 2: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/2.jpg)
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
![Page 3: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/3.jpg)
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
![Page 4: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/4.jpg)
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
![Page 5: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/5.jpg)
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
![Page 6: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/6.jpg)
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
![Page 7: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/7.jpg)
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
![Page 8: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/8.jpg)
Cryosurgery Laser ablation Conization
◦ Cold knife ◦ Laser◦ Loop electrosurgical excision procedure
Management of Abnormal Cervical Cytology Results
![Page 9: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/9.jpg)
Produces no symptoms Detected by DNA testing Primary cause of cervical neoplasia Persistent infection associated with cervical
cancer
High Risk HPV
![Page 10: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/10.jpg)
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
![Page 11: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/11.jpg)
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
![Page 12: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/12.jpg)
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
![Page 13: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/13.jpg)
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
![Page 14: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/14.jpg)
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
![Page 15: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/15.jpg)
Squamous cell carcinoma (80%–90%) Adenocarcinoma Typically slow growing, begins as dysplasia
(pre-cancerous condition)◦ Detected by Pap test◦ 100% curable
Cervical Cancer
![Page 16: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/16.jpg)
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
![Page 17: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/17.jpg)
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
![Page 18: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/18.jpg)
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
![Page 19: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/19.jpg)
Dependent upon cancer stage May include
◦ Surgery◦ Radiation therapy◦ Chemotherapy◦ Biological therapy
Cervical Cancer Treatment
![Page 20: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/20.jpg)
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
![Page 21: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/21.jpg)
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
![Page 22: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/22.jpg)
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
![Page 23: DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers Over 100 virus types with various manifestations (common](https://reader036.vdocument.in/reader036/viewer/2022062307/551bd152550346c3588b5491/html5/thumbnails/23.jpg)
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