NCLEX Review Guide: Cervical Cancer

Disease Overview

• Human Papillomavirus (HPV) is the primary cause of cervical cancer, with types 16 and 18 being most oncogenic. The virus causes cellular changes that can progress from dysplasia to invasive carcinoma over 10-15 years.
• Cervical cancer typically develops in the transformation zone where squamous and columnar epithelium meet at the cervix.

Major Risk Factors

• Multiple sexual partners, early sexual activity, immunosuppression, smoking, and long-term oral contraceptive use increase risk significantly.
• HIV-positive women have 5-10 times higher risk and require more frequent screening due to rapid disease progression.

Early vs. Advanced Symptoms

• Early cervical cancer is often asymptomatic, emphasizing the importance of routine screening with Pap smears and HPV testing.
• Advanced disease presents with abnormal vaginal bleeding (postcoital, intermenstrual, postmenopausal), pelvic pain, and foul-smelling vaginal discharge.

Diagnostic Procedures

1. Pap smear and HPV co-testing for initial screening
2. Colposcopy with directed biopsy if abnormal results
3. Staging studies: CT, MRI, PET scan for treatment planning

Surgical Interventions

• Radical hysterectomy removes uterus, cervix, upper vagina, and pelvic lymph nodes for early-stage disease. Monitor for urinary retention and bowel dysfunction post-operatively.
• Fertility-sparing procedures like trachelectomy may be considered for young women with early-stage disease who desire pregnancy.

Radiation Therapy

• External beam radiation combined with brachytherapy (internal radiation) is standard for locally advanced disease. Brachytherapy requires strict radiation precautions.
• Common side effects include fatigue, skin reactions, diarrhea, and long-term effects like vaginal stenosis and infertility.

Pre-treatment Nursing Care

• Assess psychosocial needs and provide emotional support, as cervical cancer diagnosis often causes anxiety about sexuality and fertility concerns.
• Educate about treatment options, side effects, and importance of completing entire treatment regimen for optimal outcomes.

Post-treatment Monitoring

• Monitor for complications: lymphedema, urinary dysfunction, bowel obstruction, and signs of recurrence or metastasis.
• Pelvic exams every 3-6 months for first 2 years, then annually with Pap smears and imaging as indicated.

Primary Prevention

• HPV vaccination (Gardasil 9) recommended for ages 9-26, with catch-up vaccination through age 45 based on shared clinical decision-making.
• Safe sexual practices, smoking cessation, and limiting number of sexual partners reduce risk significantly.

Screening Recommendations

• Begin screening at age 21 with Pap smears every 3 years, regardless of sexual activity onset.
• Ages 30-65: Pap smear plus HPV co-testing every 5 years (preferred) or Pap smear alone every 3 years.