As a Clinical Nurse Specialist (CNS) it is a part of my duty to develop my knowledge and provide advanced clinical and diagnostic skills during patient treatment thus enhancing the holistic patient outcome.
For the purpose of this essay I intend to critically discuss the treatment pathways and experiences of all women below 25 years of age diagnosed with cervical cancer.
This client group will be explored, focusing on how to improve care during treatment and symptom management thus improving patient outcomes.
Cervical cancer is the second most common female cancer after breast cancer in the under 35 age group. ( Bedford 2009)
In 2003 there were 24,105 new cases of carcinoma in situ (CIS) of the cervix uteri in the UK. 91% cases were registered
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in women under the age of 45, with the peak incidence in the age 25-29 age group (Cancer Research UK 2008a). The number of women aged 20-24 years who develop cervical cancer is generally fewer than 50 cases per year with 0-5 deaths and this will fall over the next 10 years as a consequence of the National HPV vaccination.(DOH 2010 ) From the global perspective the World Health Organisation (WHO) contends that cervical cancer is the second most common worldwide affliction among women (Bosch et al 2005).
World wide, it is estimated that cervical cancer is the fourth most frequent cancer in women with an estimated 530,000 new cases in 2012 representing 7.5% of all female cancer deaths.(Foran et al 2015)
Sexually transmitted infection (STI) is acknowledged as a sporadic cause of cervical cancer.The aetiological association is restricted to the family of the human papillomaviruses (HPV's) (Bosch et al, 2008).
HPV DNA can be identified in 99.7% of all cervical cancers, with HPV types 16, 18, 45 and 31 being the most frequent. (Bosch et al 2005)
A revised guideline has been published by NHSCSP for cervical screening in 2004.The recommendation is to increase the age initiation of cervical screening from 20 to 25 years.
According to Nair et al (2007), the incidence of cervical smear abnormalities is high in women under age 25. However many of these abnormalities will regress before the age of 25.Concerns have been raised whether the delay in the onset of cervical screening could have resulted in a poorer outcome and early detection if screening is offered to young women below aged
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25. An audit reviewing screening at different ages in 2003 were conducted by Sasieni et al (2003).His data shows that between 1990 and 2000 women under 25 comprised just 1.4% of all women with cervical cancer. His audit concluded that “five yearly screening offers considerable protection( 83%) against cancer at ages 55-59 years and even annual screening offers only modest additional protection ( 87%) in women aged 20 – 39 years , even annual screening is not as effective (76%) as three year screening in older women.” It also demonstrated that screening women under the age of 25 was not effective at reducing the incidence of invasive cancer.(sasieni et al 2009) Thus, in 2004, the National Health Service Cervical Screening Programme (NHSCSP) introduced new recommendations for screening intervals. Women under 25 years would no longer be offered screening and the intervals would be standardised as 3 yearly for women aged 25-49 years and 5 yearly for those aged 50-64 .( Herbert et al) The resolution was based on the capacity to develop more harm through morbidity consequent to screening than achieving positive effect by preventing cancer. This was ratified by an extraordinary meeting in 2009 and independently upheld by the UK National Screening Committee in 2012 More recently, Herbert (2015) published another study arguing that women 20-24 should not be refused of cervical screening ,although invitations need not start at age 20. Saseni however argues that the age of invitation for screening could infact be raised above 25 for those women vaccinated at the age of 11-15 as the burden of disease will be reduced substantially over the next 4 years. ( sasieni et al 2015) . .According to DOH,the cardinal symptoms of cervical cancer under 25 is post-coital bleeding, and or persistent intermenstrual bleeding. And theses symptoms requires urgent attantion. The recommendation of SIGN2 and NICE 3 guidelines is immediate speculum examination to be offered either in primary or at GUM clinic. Urgent referral to colposcopy under the two week wait rule has to be carried out if the cervix looks abnormal and suspicious. However if the cervix looks normal the recommendation is to do pregnacy testing as well as taking cervical swabs to check for presence of sexually transmitted infections(STI).On the other hand, if there is a presence of benign lesion or polyp,a routine referral to see the gynaecologist will suffice. You need to mention the doh publication re managentn of women aged 20-25 with abnormal bleeding A data base research carried out by Nair et al (2007) found that cervical carcinoma and the majority of pre-invasive disease of the cervix is associated with persisting infections with high risk types HPV, predominantly transmitted through sexual intercourse. Nair et al (2007) also states that exposure to sexually transmitted infections like Chlamydia and herpes virus type 2 or recognised as co-factors, modifying risk of progression to cancer. In the case of younger women according to NHSCSP (2016) HPV is less likely to persist, for the reason that the large number of low grade abnormalities present in cytology samples taken from women under the age 25 will retrogress naturally with time.The incidence of cervical cancer in this age group is very low (NHSCSP 2016) One of the plan of action to protect women against the detrimental effect of cervical cancer is vaccination against human papillomavirus. Two prophylactics HPV vaccines was introduced in England last September 2008.These are Cervarix and Gardasil.It offers a safeguard against human papillomavirus (HPV) types 16 and 18 which together are responsible for approximately 70% of cervical cancer according to Cresbie et al. The vaccine is offered to all girls 12-13 years and to all girls up to 18 years old as part of a catch-up campaign which started autumn 2009-2010. However, the vaccine is not as effective once a girl has become sexually active. This does not mean that the National screening will be replaced by Immunisation. (Cresbie et al) Some girls before their vaccination may have been infective with HPV or another type of HPV, hence screening attendance is a must despite women had been vaccinated. There is also a controversy following vaccinating 11-12 year olds, as many people think this will advocate promiscuity, however, according to Tanne 2006, studies have shown that early vaccination elicits the strongest immune response which weighs in favour of vaccinating at a young age. Up to now, there are still doubts about the efficacy of the vaccine in terms of decreasing the incidence of cervical cancer. Some parents of young girls were concerned about the vaccine and its safety, but despite this hesitation, recent studies show that the UK HPV vaccination programme delivered through school settings and free at the point of delivery is achieving high uptake.(Fisher et al 2014) On the other hand, another study gives information that proves contradictory to these findings, it found that there is a lower up take in levels of schools with a higher proportion of pupils from ethnic minority background. A study also conducted by Ma, R (2014), that out of 74% respondents, 57% declined HPV vaccination. This is because inadequate information was given to the respondents about HPV and they were not followed-up. Most women with high grade intra-epithelial neoplasia (CIN) are treated by excision (NHSCSP 2016 ) Women found with any pre-cancerous lesion after biopsy post colposcopy have small alternatives on how to proceed after treatment. A woman may consider on a particular recourse depending on whether or not she plans having a children at a later time, her current health status and expectancy and her apprehensions about the future and the likelihood of cancer to come back. However, to woman who has been diagnosed with cervical cancer, the treatment will vary depending on which cancers are diagnosed. Need reference here Gynaecological pathologists in the UK specifically report gynaecological cancers using FIGO staging systems. However, McCluggage et al conducted a survey to investigate whither gynaecological pathologist in the UK use FIGO or TNM staging in their routine reporting of gynaecological cancer. The study shows out of 278 gynaecological pathologist 64% use FIGO and staging while 32% use FIGO and TNM the survey also revealed that FIGO staging is recommended for gynaecological cancers, furthermore the survey supports for the use of TNM as well as FIGO staging only for cervical cancer, this is because the FIGO does not take lymph node status into account. One of the treatments for cervical cancer is trachelectomy,a fertility sparing treatment that avoids hysterectomy in early stage of cervical cancer, such as stage 1A2-1B1 (FIGO 2009). According to Philippa et al, this has been undertaken in the United Kingdom(UK) since 1994.Two types of radical trachelectomy are vaginal radical trachelectomy and abdominal trachelectomy. These two procedures have its own benefits in treating young women who has a plan to start a family in the future. Vaginal radical trachelectomy has a successful fertility outcome in treating early stage of cervical cancer, however this procedure is recommended for women with any tumour less than 2 cm, as there is a high range of recurrence for tumours that are more than 2 cm in diameter (Saso et al) On the other hand, Saso et al also suggested that abdominal trachelectomy provides a feasible, cost-effective and safe treatment option for young women who have been diagnosed with early stage cervical cancer and wish to preserve their fertility. Saso et al, also reviewed, that careful selection of patients for trachelectomy is of paramount importance. The size of the tumour should be considered prior to deciding between abdominal radical trachelectomy or vaginal radical trachelectomy is more suitable for treating women with early stage cervical cancer and who wish to preserve their fertility. Young women diagnosed with cervical cancer initial thought is to get rid of the cancer and one treatment choice is hysterectomy. This procedure can be a life saving procedure; however for women who plan to have a family in the future this is not the best option. Hysterectomy is the surgical removal of the uterus. According to Andreas Stang, hysterectomy is the most frequently performed major surgical procedure in gynaecological across many places in the world. It is also one of the most performed procedure by the gynaecological oncologist, according to Nobbenhuis According to FIGO, stages 0-1A1, the surgical treatment has limited spectrum (ionization, cervical amputation, simple hysterectomy or radical trachelectomy) Radical hysterectomy with pelvic lymphadectomy is the treatment of choice for cervical cancer in FIGO stages 1A2-11A. It was demonstrated by Kusy et al, that operative methods, irradiation and combined treatment consisting of surgical techniques, radiotherapy and chemotherapy are applied in the management of cervical cancer. The treatment choice is dependent first of all on the disease advancement. For women who have been diagnosed with cervical cancer that has progressed to a stage greater than 1B2 wherein stated by FIGO as cervical cancer clinical lesion is greater that 4cm in size, one recommended treatment is pelvic radiotherapy. According to Mehmood et al, it is a well-established treatment in the management of gynaecological cancers either post operatively or as a primary treatment. Simultaneously this treatment can be used either on its own or with surgery. But one of the increasing apprehensions of the treatment is about the late complication such as infertility. Talking in detail about fertility presevation is essential part of safeguarding a young woman's quality of life after cancer. According to Cairns et al, in 1999, the US National Cancer Institute (NCI) issued a statement that concurrent chemotherapy and radiotherapy should be considered for all patients with advanced cervical cancer. It is also now considered the standard treatment of advanced cervical cancer. Cairns et al also stated that a woman with cervical cancer that has progressed to a stage greater than 1b2, radiotherapy together with chemotherapy gives the best possibility of curing the disease. Today, there are several ways to preserve woman's fertility when treating invasive cervical cancer.
The aspiration of conceiving after the treatment is very promising to those women with small localised invasive cervical cancer. Numerous women nowadays are postponing childbearing and fertility preservation has turn out to be a major deliberation.
According to Jeffries 2002, the holistic care of a patient encompassing her physical, psychological, social, spiritual and sexual needs is the aim of all nurses and health care professionals.
Macmillan Cancer Support is one of the organisation that offers support from the time a woman has been diagnosed with cancer and all throughout her cancer journey. But most importantly we need to consider the experiences and the journey of these women who has been diagnosed of cervical cancer.How they and their families coped with this fatal disease.The impact on thei
The nurse needs to be able to deal with different emotions and offer support to the patients, as well as being able to use evidence-based practice to influence their clinical decision-making skills (Bedford,S 2009).
The role of the nurse is vital in disseminating information about cervical screening and accurate information about HPV vaccination. Encouraging women to practice healthy lifestyle and advocating safer sex empowers young women to be cautious with their sexual
health.
As a nurse, it is important to address the needs of a patient during care. These needs are unique to each individual and personalizing it, enable the patients to feel truly cared about. It is important to be educated about these needs as the patients and their families look to you as a guide; therefore, education on things w...
At that point, more than 15,000 women were dying each year from cervical cancer. The Pap smear had the potential to decrease that death rate by 70 percent or more, but there were two things standing in its way: first, many women- like Henrietta-simply didn’t get the test; and, second, even when they did, few doctors knew how to interpret the results accurately, because they didn’t know what the various stages of cervical cancer looked like under a microscope. (29)
Cervical cancer tissues and normal cervical tissues were collected from 24 newly diagnosed patients with primary cervical cancer, in order to perform the experiments outlined in the paper. Experiments were also performed on the following human cervical carcinoma cell lines: HeLa, SiHa, C33A, and CaSki, which were purchased from a company. The researchers extracted the genomic DNA from the samples collected. The DNA was then bisulfite modified and amplified using PCR. The PCR product was then examined through gel electrophoresis to insure a single band was obtained, and then sequenced by Invitrogen. Methylation-specific PCR was then carried out of the bisulfate-treated DNA. This was done to check the consistency of the ...
What is the human papillomavirus (HPV)? According to the US government’s National Cancer Institute, human papillomaviruses (HPVs) are a collection of more than one hundred viruses, many types having the ability to grow tumors or polyps that are malignant and others benign. Certain of the viruses are capable of forming genital warts. The HPVs that cause the common warts on hands and feet are different from those that cause growth in the throat or genital area (Human Papillomavirus). Professors Joe Cummins and Dr. Mae-Wan Ho inform us that some types are associated with cancer, and are called “high risk” HPVs. Of the more than one hundred types of HPVs, over thirty can be passed on through sexual contact. Most HPV infections occur without any symptoms and go away without treatment over the course of a few years. However, HPV infection sometimes persists for many years, with or without causing detectable cell abnormalities. Infection from “High risk” types of HPV is the main cause of cervical cancer. Pap smears have also led to earlier detection of these infections. Nearly all women who are sexually active will have HPV inf...
We are not only responsible for patient care, but we are also included in many other roles. Before nursing school, I thought that the main responsibility of the nurse is to take care of patient. During nursing school, I learned that patient care was not the nurses known just for. We took many general courses and nursing course work to prepare ourselves to be an educated member. For example, it was required to us to take microbiology, anatomy, leadership, professionalisms, etc to help us to become a better nurse and have a foundation base of education. We give patient care in the hospital, but we are also provider of care. We use the nursing process to help and make decision for our patient. Our decisions are based on critical thinking, clinical reasoning, and accountability. We are hold accountable for everything we do and based on our judgment to provide care to the best of patient’s benefit. We are also known for our role as a manager, designer, and coordinator of patient care. I plan and coordinate patient’s care based on their health care needs. In clinical, my patient has a Foley catheter, I will know to plan and implement Foley care to help with personal hygiene and preventing infections. It is important to make decisions based on priorities, time, and resources. As nurses, we need to know how to delegate and ask for assistance when needed. For example, I needed help to ambulate my patient who has a total knee replacement, I then ask
The Information gathered in 2012 from Centers for Disease Control and Prevention studies concluded that cervical cancer, “... used to be the leading cause of cancer death for women in the United States” (“Cervical Cancer Statistics”). But these statistics have gone down significantly in the past forty years because Planned Parenthood facilities provide to women pap smears to detect cell changes before the cancer develops. On the other hand, Planned Parenthood does not directly provide mammograms for women, their doctors and nurses “... teach patients about breast care, [and] connect patients to resources to help them get mammograms” ("Breast Cancer Screenings"). The important health care work done by the Planned Parenthood Clinics is, at times, over sought and even forgotten when the organization is embroiled in controversy as it finds itself in
Cervical cancer is formed in the tissues of the cervix, an organ that connects the uterus and the vagina. Virtually all cervical cancers are caused by Human papillomavirus (HPV) infections (Schiffman et. al., 2007). HPV is the most common sexually transmitted infection in the United States. According to the CDC, 75% of sexually active people aged 15-49 have the infection at some point in their lives. (CDC). Because HPV infection is usually asymptomatic, infected people do not know exactly when they get the infection. In most cases, the body is able to fight off the virus before any symptom. However, health problems such as genital warts and cancer may result with persistent exposure to HPV.
My philosophy is based on my personal values and beliefs as it relates to the body of work in nursing. The practice of nursing not only involves applying knowledge but the ability to differentiate the needs of the client and being empathetic to their needs. Hence, the importance of holistic nursing and not only being for the client but for the clients family as well. Holistic nursing is defined as “all nursin...
Over the years, the fight against ovarian cancer has proven to be even more difficult due to the cancer being asymptomatic at its early stages. For this reason, there are constantly late diagnoses made on women who unfortunately develop this cancer (Stack).... ... middle of paper ... ...
Holistic nursing provides a personal, caring, and respectful relationship between the nurse and the patient. Holistic nursing has concepts that allows the patient to feel like their values and opinions are heard and respected. This field of nursing focuses on open communication, alternative treatment as well as comprehensive care. All three of these components are attracting patients to get care in this field, when today’s health care is increasing becoming impersonalized. Holistic care is growing
Routine screening of all asymptomatic sexually active teens has been attempted but has not worked out. The reason is that the cost of such a screening program is prohibitively high and students and teenagers are often paranoid about their privacy and unwilling to participate (Llata et al, 2015). For over a decade, the rates of STDs in adolescents and teenagers have been rising in almost every city in the US. Thus, now researchers are asking two questions: 1) what is causing this rise in STDs? and 2) What can one do to counter it? In order to answer these two questions it is impor...
Stoate, H. G. (1989). Can health screening damage your health? J Roy Co11 Gen Practitioners; 39:193-195.
Uterine cancer is an important women health problem developing rapidly, killing over 200,000 women each year. No one has discovered the actual cause, but there is a leading factor that has great suspicions to what is causing this cancer to grow rapidly.
...with others families who have experienced the same ordeal and share what they have learned about coping with cancer and the many side effects of treatment. Overall cancer is a disease that can change a person’s world completely. For many it comes as a surprise because no one expects to get cancer. This diagnosis can bring on so many mixed emotions from anger to depression. That is why a strong support system is the best medicine for these patients emotionally. With uterine cancer, early diagnosis is the key, but so many women often deny signs and symptoms passing it off for nothing. As women we must understand that it is very important to maintain good health and get regular yearly physicals. For those who have a family history of cancer it is very important to start getting testing as early as possible. Early detection is the key to preventing and treating cancer.
Cronin, H., Duggan, E., O'tuathaigh, C. and Doran, K. (2013) Attitudes of General Practitioners to Prescribing Contraception to Minors - A Medico-Legal Review. Medico-Legal Journal of Ireland [online], 19 pp. 28-33. Available at: http://login.westlaw.ie.ezproxy.wit.ie:2048/maf/wlie/app/document?&srguid=ia744cc64000001450ea3b61054c0346f&docguid=I0C630E0741C1444E8B5A4451F62D10C7&hitguid=I0C630E0741C1444E8B5A4451F62D10C7&rank=2&spos=2&epos=2&td=7&crumb-action=append&context=9&resolvein=true [Accessed: 29 Mar 2014].