Gender Ethnicracial And Life Span Considerations

Although cervical cancer can occur from the late teens to old age, it occurs most commonly in women 35 to 55 years of age. Preinvasive cancer of the cervix is most commonly seen in the 25-to 40-year-old woman, whereas invasive cancer of the cervix is more common in the 40- to 60-year-old. African American women and women from lower socioeconomic groups are the highest risk groups for cervical cancer.

Cervical Cancer DRG Category:

Mean LOS: Description:

DRG Category: Mean LOS: Description:

^ ASSESSMENT

HISTORY. Because early cervical cancer is usually asymptomatic, establish a thorough history with particular attention to the presence of the risk factors and the woman's menstrual history. Establish a history of later symptoms of cervical cancer, including abnormal bleeding or spotting (between periods or after menopause); metrorrhagia (bleeding between normal menstrual periods) or menorrhagia (increased amount and duration of menstrual bleeding); dysparuenia and postcoital bleeding; leukorrhea in increasing amounts and changing over time from watery to dark and foul; and a history of chronic cervical infections. Determine if the patient has experienced weight gain or loss; abdominal or pelvic pain, often unilateral, radiating to the buttocks and legs; or other symptoms associated with neoplasms, such as fatigue.

PHYSICAL EXAMINATION. Conduct a pelvic examination. Observe the patient's external genitalia for signs of inflammation, bleeding, discharge, or local skin or epithelial changes. Observe the internal genitalia. The normal cervix is pink and nontender, has no lesions, and has a closed os. Cervical tissue with cervical cancer appears as a large reddish growth or deep ulcerating crater before any symptoms are experienced; lesions are firm and friable. The Pap smear is done before the bimanual examination. Palpate for motion tenderness of the cervix (Chandelier's sign); a positive Chandelier's sign (pain on movement) usually indicates an infection. Also examine the size, consistency (hardness may reflect invasion by neoplasm), shape, mobility (cervix should be freely movable), tenderness, and presence of masses of the uterus and adnexa. Conduct a rectal exam; palpate for abnormalities of contour, motility, and the placement of adjacent structures. Nodular thickenings of the uterosacral and cardinal ligaments may be felt.

PSYCHOSOCIAL. Uneasiness, embarrassment about a pelvic examination, or fear of the unknown may be issues for the patient. Determine the patient's level of knowledge about a pelvic exam and what she expects. Determine her recommended Pap test screening schedule, as well as how she obtains the results and their meaning.

If the patient requires follow-up to a positive Pap smear, assess her anxiety and coping mechanisms. Stressors may be fear of the unknown, of sexual dysfunction, of cancer, or of death, or she may have self-concept disturbances.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Papanicolaou examination (Pap smear)

Colposcopy followed by punch biopsy or cone biopsy (via LEEP, loop electrosurgical excision procedure)

No abnormality or atypical cells noted

Benign results

High class/grade cytologic results

Malignant cells

Initial screening; indicates a need for further testing

Vaginal vault and cul-de-sac are visualized; malignant diagnosis can be confirmed

Other Tests: Chest x-ray, cystoscopy, proctosigmoidoscopy, intravenous pyelogram, barium studies of lower bowel, ultrasound, computed tomography, magnetic resonance imaging, and lymphangiography

214 Cervical Cancer

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