Cervical+Cancer

**What is Cervical Cancer?** Cervical cancer is one of the most common forms of cancer affecting female reproductive health. Worldwide, It is the third most common form of cancer in women (Botti, 2011). The cervix is located at the lower end of the uterus and leads to the outside of the body. The cervix is made up of two types of cells, squamous and columnar, while most cancer is found in the squamous cells. Cervical cancer ranges in severity, from stages 0-IV. Stage 0 cervical cancer is the least severe and is localized in the outer layer of the cervix. As the stages progress, the cancer can spread throughout the female reproductive organs to other parts of the body. When this happens, the cancer is said to be in stage IV (Cancer, Cervix, 2010). In the United States today, the number of women diagnosed with cervical cancer is decreasing due to regular Pap smear tests that detect possible abnormalities. Because one of the leading causes of cervical cancer is due to HPV, symptoms are rarely presented and women who do not get regular tests are usually diagnosed at late stages of the disease.
 * Cervical Cancer**

**Risk Factors:** There are several risk factors that can lead to cervical cancer. These may include having multiple sexual partners, engaging in sex at young ages, coming from a low socioeconomic background, and having a weak immune system (Chen, 2010).

**Symptoms:** Many times, symptoms do not initially present themselves but signs of cervical cancer may include abnormally heavy vaginal bleeding, back and bone pain, fatigue as well as weight loss and loss of appetite (Chen, 2010).

**Screening Tests:** Cervical screening tests, or Pap smears, are tests designed to look for abnormalities in the cells of the cervix and prevent the development of cervical cancer. During a Pap smear, the doctor uses a device called a speculum to open the vagina in order to view the cervix. A “multi-fronded brush” is then used to gather cells from the cervix (Cooper, 2011). After the cells are collected, they are placed in a solution and sent to be tested for abnormalities at a laboratory. It is recommended that regular screenings be done when a woman turns 21. There is a 95% cure rate of abnormal cells if they are detected and treated early enough (Cooper, 2011). I t is extremely important that women go to their screening tests when scheduled and follow up with their doctors in order to minimize their risk of developing cervical cancer. Still, issues arise when it comes to screening tests. One study found that women who come from an area where there is high incidence and mortality of cervical cancer had better attitudes toward screening tests then those who came from areas where cervical cancer was not very prevalent. This same study also showed that women who had previous abnormalities or cervical cancer in the past were more likely to get Pap tests and more likely to get their daughters screened from young ages then those who had never had abnormal screenings (Salz, Gottlieb, Smith, & Brewer, 2010). Some women do not get screened because they are not comfortable with the situation. Reasons listed include embarrassment, shame, feel it is not relevant to them, uneducated about the risks associated with not being tested, unable to find a female doctor, and the inconvenience of times available. Factors that play a key role in who decides to get screened include ethnicity, socioeconomic status, history of sexual abuse, women who are not sexually active, lesbian and bisexual women, post-menopausal women, etc. Minority ethnicities had a low percentage of women screened when compared to white women. Socioeconomic issues are correlated with a the low number of people who get cervical screening tests. Of the factors listed, the only one that does not require a screening test is a woman who has never been sexually active, although she may have one if she so chooses (Cooper, 2011). Physicians and nurses must keep these factors in mind when handling patients who fit into these categories. They need to be educated on how to handle situations with sensitivity and learn how to communicate with their patients effectively in order to establish a comfort level. Clear explanations of what exactly happens during these tests, including making the patient aware of what instruments are being used to do what, can help ease nerves and establish trust.

**HPV and Prevention Methods:** Human Papillomavirus, or HPV, is a sexually transmitted disease that is extremely common in sexually active women. One in two women who are having sex have already had or are going to have the disease at some point in their lives. There are many different forms of HPV, and some of these put women at a very serious risk of developing cervical cancer. It can be very dangerous because many times there are no obvious symptoms of the infection and although it may go away on its own, some untreated cases can lead to serious health risks. The two types that are commonly associated with cervical cancer are types 16 and 18. Since these have been identified, there have been two vaccinations created, known as Gardasil and Cervarix, that are administered to young adults to prevent these two forms. These vaccinations are most effective if done before any exposure to the Human Papillomavirus so doctors are recommending girls get them as young as 11 years old. Both require a series of three shots over a six month time period in order to be most effec tive (“Human Papillomavirus”, 2009). Two of the most common forms of cervical cancer are squamous cell carcinoma and adenocarcinoma (Botti, 2011). In one study done on the prevalence of HPV DNA associated with cervical cancer, it was found that 94.1% of women with squamous cell carcinoma contained this DNA. Also, adenocarcinoma, which effects epithelial cells, had HPV DNA present in 93% of the cases researched (Ramet, van Esso, & Meszner, 2011). Although both types 16 and 18 do put women at a high risk of developing cervical cancer, usually other factors co-contribute to the disease. Older women are at a greater risk as well as women who have other strands of HPV along with 16 and 18. Smoking and other STDs are also important contributing components. With the more information we learnabout HPV and the different preventative measures for the development of cervical cancer, it is important for schools to educate their students about the dangers of HPV and the vaccinations that are important for them to receive at young ages. Also, schools could possibly add the HPV vaccination to their routine required vaccinations to help parents realize the importance of early prevention (Ramet, van Esso, & Meszner, 2011). Parents, many times, do not feel that a child as young as 11 should be receiving a vaccination for an STD and they need to be able to receive proper information from health care professionals. Pediatricians need to be able to effectively communicate the benefits of receiving this vaccination at such a young age, and be able to help the parents feel comfortable enough to allow them to administer it.

**Treatment:** If the cancer is found in the early stages, different treatment methods, such as cryotherapy (freezing) and/or laser therapy (burning) are used to destroy the bad cancerous cells and keep the uterus intact. If the cancer is found in the later stages, the procedures and consequences are much more severe. A hysterectomy (removal of the uterus), radiation, and/or chemotherapy may need to be done in order to treat the cancer, especially if it has spread to other areas of the body (C hen, 2010).

References: Botti, G. Tornesello, M.L., Losito, S.L., Benincasa, G., & Fulcinit, F.(2011). Human papillomavirus (hpv) genotypes and hpv16 variants and risk of adenocarcinoma and squamous cell carcinoma of the cervix. Gynecological Oncology, 121(1)

 Cancer, cervix. (2010). http:// [|__www.mdguidelines.com/cancer-cervix/definition__]

 Chen, Y. (2010, December 28). Cervical cancer. http:// [|__www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001895/__]

 Cooper, M. (2011). Reasons for non-attendance at cervical screening. Nursing Standard, 25(26), [|__http://content.ebscohost.com.proxy2.library.illinois.edu/pdf25_26/pdf/2011/4ER/02Mar11/59632497.pdf?T=P&P=AN&K=59632497&S=R&D=aph&EbscoContent=dGJyMMvl7ESep684v%2BbwOLCmr0mepq9SsKq4SrOWxWXS&ContentCustomer=dGJyMPGut1C3rLZNuePfgeyx44Dt6fIA__]

 Human papillomavirus (hpv). (2009, December 15). [|__http://www.youngwomenshealth.org/hpv.html__]

Ramet, J., van Esso, D., & Meszner, Z. (2011). Position paper—hpv and the primary prevention of cancer; improving vaccine uptake by paediatricians. European Journal of Pediatrics 170 (3), [|__http://www.springerlink.com.proxy2.library.illinois.edu/content/l0lp0p16v6002040/fulltext.pdf__]

 Salz, T., Gottlieb, S.L., Smith, J.S., & Brewer, N.T. (2010). The association between cervical abnormalities and attitudes toward cervical cancer prevention. Journal of Women's Health, 19(11)