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Human Papillomavirus

Chapter 06 Promoting Reproductive Health Through an Understanding of Cervical Cytology Screening, Human Papillomavirus, and Cervical Cancer. Human Papillomavirus. DNA tumor virus Associated with premalignant/malignant cervical disease and other cancers

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Human Papillomavirus

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  1. Chapter 06Promoting Reproductive Health Through an Understanding of Cervical Cytology Screening, Human Papillomavirus, and Cervical Cancer

  2. Human Papillomavirus • DNA tumor virus • Associated with premalignant/malignant cervical disease and other cancers • Over 100 virus types with various manifestations (common warts, plantar warts, skin cancers, anal/genital warts) • Most common STD in the U.S.

  3. The Uterine Cervix • Squamous epithelium • Columnar epithelium • Meet at the squamocolumnar junction • Squamous metaplasia: process of change from columnar to squamous cellls • Transformation zone: area between old and new SCJ

  4. Cervical Cancer Screening • Papanicolaou (Pap) test - 1940s • Cytological study for detecting cancer • Worldwide, most widely used cancer screening method • Can detect 95% of all cervical cancers and precancerous abnormalities • Dramatically reduces cervical cancer death rates

  5. Cervical Cancer Screening • Begin at age 21 • Every 2 years ages 21–29 • Age 30+: if three consecutive negative results, screen every 3 years unless special risk factors • HIV+ or DES or previous cervical cancer • Immunosuppressed

  6. Optimizing Cervical Cancer Screening • Collect cytology sample at mid-cycle • Teach patients: for 24–48 hours prior to testing • Avoid intercourse • Avoid vaginal medications • Avoid douching • Document all communication re: Pap testing

  7. Cervical Cancer Screening in Older Women • May discontinue after age 65–70 if three consecutive negative tests and no abnormal test findings in previous 10 years (ACS,USPSTF, ACOG)

  8. Management of Abnormal Cervical Cytology Results • Cryosurgery • Laser ablation • Conization • Cold knife • Laser • Loop electrosurgical excision procedure

  9. High Risk HPV • Produces no symptoms • Detected by DNA testing • Primary cause of cervical neoplasia • Persistent infection associated with cervical cancer

  10. HPV DNA Testing • Performed on vaginal/cervical cell sample collected for a Pap test • Assesses for one or more potentially cancer-causing HPV types • Recommended for women 30+ years old

  11. HPV Infection: Manifestations • Abnormal Pap test results • External genital warts (1%) • Condylomaacuminata, smooth papular warts, keratotic genital warts, flat warts • Cervical lesions (10%) • Majority heal through natural immune response • Some persist and progress to cervical cancer

  12. HPV Infection/HPV-Related Cervical Disease: Risk Factors • Cigarette smoking • Greater than three lifetime sex partners • New sex partner within past 12 months • Drug use within past 12 months • Intercourse while alcohol-impaired • Never married

  13. Patient Teaching to Reduce Cervical Cancer Risk • Healthy lifestyle • Diet • Avoid chemical/environmental hazards • Sexual health awareness (e.g., condoms, monogamous relationship) • Prophylactic HPV vaccination

  14. HPV Vaccines • Gardasil – HPV types 6, 11, 16, 18 • Also approved for use in males • Cervarix – HPV types 16, 18 • Three intramuscular injections • Ideally administered before initiation of sexual activity • Avoid during pregnancy

  15. Cervical Cancer • Squamous cell carcinoma (80%–90%) • Adenocarcinoma • Typically slow growing, begins as dysplasia (pre-cancerous condition) • Detected by Pap test • 100% curable

  16. Cervical Cancer Risk Factors • HPV infection, immunosuppression • Cigarette smoking, alcoholism, poor nutrition • Co-infection with other STDs • Early onset of sexual activity, multiple sexual partners, early age first full-term pregnancy • Inadequate cervical screening • In utero DES exposure • Family history of cervical cancer

  17. Cervical Cancer Symptoms • When present, may include • Continuous vaginal discharge • Abnormal vaginal bleeding • Heavier, longer menstrual periods • Loss of appetite, weight loss • Fatigue • Pelvic pain, back pain, leg pain

  18. Cervical Cancer Work-Up • To determine spread, testing may include • X-ray computed tomography • Magnetic resonance imaging • Positron emission tomography • Cystoscopy • Chest x-ray • Intravenous pyelogram

  19. Cervical Cancer Treatment • Dependent upon cancer stage • May include • Surgery • Radiation therapy • Chemotherapy • Biological therapy

  20. Chemotherapy for Cervical Cancer • Used for metastatic or recurrent cancer • May be oral or intravenous • May be used in combination with other chemotherapeutic agents • May be combined with RT or surgery

  21. Chemotherapy Patient Teaching • Common side effects • Nausea and vomiting • Change in appetite, oral lesions • Vaginal sores • Temporary hair loss • Fatigue • Anemia, bruising, skin rash, infection susceptibility • Menstrual cycle changes, infertility • Pain, swelling in legs and feet

  22. Biological Therapy • Used for metastatic cancer • Interferon most common therapy • Sometimes combined with chemotherapy • Usually administered on outpatient basis • Counsel about side effects: flu-like symptoms, rash, anorexia, bruising

  23. Nursing Role in Cervical Health Promotion • Education – all ages • Cervical cancer screening • Cervical cancer symptoms • Relationship between HPV and cervical cancer • Strategies to reduce HPV risk • Support for state, federal funding

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