Cervical Cancer Prevention and Treatment



Cervical Cancer Prevention and Treatment

Tammy Garcia and Joanna Matthews

Ferris State University

Abstract

This paper is a research document that explained the importance of health promotion in regards to cervical cancer. Despite the controversial discussions surrounding cervical cancer, there are many options available for prevention. Prevention measures are favored, but several treatment options are available for diagnosed cervical cancer. This paper outlined several important rationales to allow nurses to realize their role in health promotion. Education and nursing involvement continues to be very important to protect the public.

Cervical Cancer Prevention and Treatment

Cervical cancer is likely a familiar topic not just among women, but among nurses as well. It is the second most common type of cancer among women worldwide (Cothran & White, 2002). In recent years, the topic of cervical cancer has come to the mainstream media in regards to the debates over a preventative vaccine. This specific type of cancer has various causes, but a common link between the human papillomavirus (HPV) and cervical cancer has been identified. The frequency of this cancer can affect females of various ages. The importance of educating the public on this health promotion topic is essential to help raise awareness about the disease state and prevention measures.

In general, cervical cancer is a type of carcinoma that “affects the cervix, uterus, pelvis, and in extreme circumstances the lymph glands and other body systems” (Bedford, 2009, p. 80). Bedford suggests that despite the link existing between cervical cancer and HPV, not all of the 100 types of HPV predispose one to cervical cancer. HPV is passed by contact of the genitals with infected secretions from the vagina, cervix, vulva, penis, or anus. Since the HPV infection can involve such a large area, often condom use does not adequately protect one from transmission. It is essential that education be provided to inform the public about HPV as well as its associated risks to help protect the population. Educating the public on this topic will also help prevent misconceptions that are common when discussing conditions such as HPV and cervical cancer.

Prevention

There are many actions that can be done to help prevent or significantly decrease a woman’s risk of cervical cancer. Two strains of the HPV virus, genotypes 16 and 18, specifically are contributing factors to “approximately 70% of squamous cell carcinomas and around 80% of adenocarcinomas worldwide” (Garland & Smith, 2010, p. 1079). A vaccine named Gardasil was developed to offer protection against genotypes 6, 11, 16 and 18. The vaccine is recommended as a routine vaccination for girls’ ages 11 and 12. The vaccination is also recommended for girls and women between the ages of 13 and 26 who were not immunized earlier in life. The vaccine is thought to prevent up to 70% of cervical cancer cases and is most effective if given before the girl or woman becomes sexually active. Gardasil is given in 3 doses. The vaccination schedule is the first initial dose, then the second dose is given 2 months after the first, and the third dose is given 6 months after the initial dose (Merck Vaccines, 2010). Advertisement and encouragement of the vaccine has been controversial because many believe that this would encourage promiscuity. According to Bedford (2009), “studies have shown that early vaccination elicits the strongest immune response, which weighs in favor of vaccinating at a young age” (p. 82).

Delaying becoming sexually active and limiting the number of sexual partners will help to reduce the risk of cervical cancer. When having sex, using a condom will help decrease the risk of not only HPV but also other sexual transmitted diseases (STDs). Having any STD can increase the risk for cervical cancer. As mentioned earlier, education is essential to inform the public that while condoms decrease the risk of HPV transmission, it does not prevent in all circumstances.

Smoking is a risk factor for many cancers including cervical cancer. If a woman is a smoker and has HPV not only is the risk increased but also the combination can accelerate the progression of it. Avoiding second hand smoke is important as well. Bedford (2009) suggests this may be because “smoking may be associated with a decrease in the number of Langerhans’ immune cells in the cervix epithelium, suggesting a decrease in epithelial cell-mediated immune responses in smokers” (p. 81).

One of the most important things that a woman can to do help prevent developing cervical cancer is to get regular Papanicolaou (Pap) screening. Regular Pap smears can help detect any abnormal changes in the cervix before cervical cancer develops. The most current recommendations from the American College of Obstetricians and Gynecologists (ACOG) for Pap test screening are based upon a woman’s age and history.

According to the new ACOG guidelines, women aged 21 to 30 years should be screened every 2 years using either the standard Pap test or liquid-based cytology. Women 30 years and older who have had three consecutive negative (i.e., normal) cervical cytology test results may be screened once every 3 years with either screening test. Women older than 30 years can also be co-screened with a combination of the Pap test and an HPV test; if they receive negative results on both tests they do not need to be rescreened for at least 3 years. The ACOG guidelines also note that women with certain risk factors may need more frequent screening. These risk factors include being infected with human immunodeficiency virus (HIV), being immunosupressed, having been exposed to diethylstilbestrol before birth, and having been treated for certain cervical abnormalities or cancer. Women aged 65 to 70 years who have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years may decide, after talking with their doctor, to stop having Pap tests. Women who have had a hysterectomy (surgery to remove the uterus and cervix) do not need to have a Pap test, unless the surgery was done as a treatment for a precancerous condition or cancer. (National Cancer Institute, 2010, para 8-9)

Because of the effectiveness of Pap screening, “pre-invasive lesions of the cervix are detected more often than invasive cancer” (Bush, 2010, p. 33). Sharing such an important fact with the public might improve compliance with recommended testing schedules.

Treatment

The prognosis for successful treatment and survival of cervical cancer is affected by the stage of the disease at time of diagnosis. “A vast majority (greater than 90%) of these cancers can and should be detected early by use of the Pap test and human papillomavirus (HPV) testing” (National Cancer Institute, 2011, para 1). Being able to have such high percentages from Pap testing is encouraging because many cervical cancers are able to be caught in the early stages before the spread of cancerous cells has the opportunity to cause more harm to the body.

Treatment for cervical cancer includes: surgery, radiation, and chemotherapy. If the cancerous cells are confined to the cervix and non-invasive, removal of the cancerous cells is all the treatment that is needed. The cancerous cells can be removed by: cone biopsy, laser surgery, loop electrosurgical excision procedure (LEEP), cryosurgery or hysterectomy. For cancers that have become invasive and have spread to deeper cellular layers of the cervix, treatment will depend on the stage of the cancer and health problems of the patient. Treatments for invasive cervical cancer include hysterectomy (surgery), radiation, and chemotherapy.

An important part of the treatment phase for cervical cancer also requires a lot of emotional support. Often, women who are diagnosed with cervical cancer may feel self-conscious due to the many misconceptions held about cervical cancer by the general public. Any emotions such as anger, fear, guilt, or embarrassment requires having appropriate support available through family, friends, or even health care personnel. Allowing the patient a holistic environment to address their emotional, physical, and spiritual needs will allow for most beneficial patient responses.

Conclusion

Many different types of cancer have the potential to cause pain and death on a daily basis. As physicians, researchers, and organizations work to find a cure for cancer, it is reassuring to know that developments have been made in regards to cervical cancer. Although cervical cancer is not cured, having Pap testing available for women has allowed for speedier detection of abnormal cervical cells. Availability of vaccinations for girls and young women has also allowed the prevention of certain genotypes of HPV transmission.

Having available options in the prevention of cervical cancer is great, but is only effective if community members are aware of the actions needed. Education has been a large factor in encouraging women to get their advised Pap smears. Recent advertisements by pharmaceutical companies as well as health departments have provided education and encouragement of the Gardasil vaccine. It is essential that nurses be educated on the topic of cervical cancer to help provide accurate unbiased information to patients. “Only through making the public more aware of the nature of cervical cancer will deaths be prevented” (Bedford, 2009, p. 83).

References

Bedford, S. (2009). Cervical cancer: physiology, risk factors, vaccination and treatment. British Journal of Nursing, 18(2), 80-84.

Bush, N. J. (2010). Cervical cancer screening in young women: saving lives with prevention and detection. Oncology Nursing Forum, 37(1), 33-38.

Cothran, M. M., & White, J. P. (2002). Adolescent behavior and sexually transmitted diseases: The dilemma of the human papillomavirus. Health Care for Women International, 23, 306-319. doi 10.1080/073993302317346352

Garland, S. M., & Smith J. S. (2010). Human papillomavirus vaccines, current statistics and future prospects. Drugs 2010, 70(9), 1079-1098.

National Cancer Institute (2010). Pap Test Fact Sheet. Retrieved March 11, 2011 from

National Cancer Institute (2011). Cervical Cancer Treatment (PDQ). Retrieved March 7, 2011 from ages/Print

Merck Vaccines .(2010). Gardasil: Dosing and Administration. Retrieved March 11, 2011 from

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