Cervical Cancer: Pathophysiological Processes

Abstract

Cervical cancer is a disease that is frequently observed in women regardless of their geographical location. It is usually characterized by the presence of human papillomavirus in the cervix or genetic changes that may promote the growth of this disease. Cancer cells are not always easy to recognize at their initial stages. Therefore, many women live with cervical cancer without being aware of it. In this paper, pathophysiological processes associated with cervical cancer will be discussed to understand what diagnostic methods, treatment modalities, and educational interventions can be offered to patients by nurses and healthcare workers. HPV vaccinations, Pap tests, and regular screenings should be used to reduce the occurrence and increase the early detection of cancer. Women have to know the main risk factors as well as the signs and symptoms of cervical cancer so that they will be ready for treatment through surgery, radiotherapy, and chemotherapy.

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Introduction

Cervical cancer is one of the most frequent types of cancer that affects women around the world. The disease is characterized by the growth of cells that cannot be controlled and that has a serious impact on the functioning of the entire body. When cancer affects the cervix—that is, the lower part of the uterus—it is called cervical cancer. Early diagnosis is essential because the cervix is an important organ in the female reproductive system that, despite its small size, performs a crucial function in connecting the vagina and the uterus. Cervical cancer is the cause of 275,000 deaths around the globe annually (Pierangelo et al., 2013). Still, the Centers for Disease Control and Prevention (2013) classifies this disease is highly preventable in most women due to the availability of screening tests and vaccines that are used to prevent infections caused by the human papillomavirus (HPV). Cervical cancer at a young age is a rare condition, however, and not many women are eager to spend much money and time on screening and counseling. The result is an inability to detect the disease in time.

In this paper, the pathophysiology of cervical cancer, its clinical manifestations and assessments, the most appropriate diagnostic tools and treatment, and patient education will be discussed. The discussion will also include a case study of a 50-year-old woman who visits a hospital complaining of vaginal bleeding and abdominal pain. An understanding of the pathophysiological processes of cervical cancer and a clear diagnosis plays an important role in cancer treatment and saving human lives.

Pathophysiology of the Disease

Cervical cancer does not in itself belong to sexually transmitted diseases. However, it is necessary to point out that HPV, the actual cause of cancer in the body, is sexually transmitted. To clarify the reasons for the growth of cancer cells in the cervix and identify health problems at early stages, special attention is paid to the pathogenesis of cervical cancer, its molecular analysis, and its physiology. If doctors fail to describe and understand the pathology in the right way, all the following activities may be incorrect and ineffective.

Skin-to-skin contact promotes the possibility of transmission of HPV. The virus infects basal cells, with other cells being relatively resistant (Pierangelo et al., 2013). The cervix has two types of epithelium: endocervical (the superior part of the cervix) and squamous (the distal part, where 90% of malignancies usually occur) (McCance, Huether, Brashers, & Rote, 2015). As soon as HPV reaches the cells in the basal layer of the epithelium, the DNA replication cycle begins (Amaro-Filho et al., 2013). In the virus, two viral proteins, E1 and E2, begin to destroy cervical cells, promoting the creation of new episomal copies of the viral cells containing the dangerous genomic material.

A part of the cells stays in the basal layers, and another part of the cells continues moving to the suprabasal layer being stimulated by the E2-E5 genes. Products of E6 and E7 are the key proteins that are responsible for the initiation of tumors in the cervix (Fang, Zhang, & Jin, 2014). It is also thought that HPV affects the expression of p53 proteins, which would establish a positive correlation between this protein and lesions and cervical cancer (Amaro-Filho et al., 2013). These lesions are spontaneous and may regress over the next 2-3 years, depending on genetic predisposition, the number of infections, and hormone levels.

Clinical Manifestations and Assessments

One particular feature of clinical manifestations of cervical cancer is the inability to identify problems or changes with the naked eye. Though awareness of risk factors is a significant step toward preventing cervical cancer, this knowledge may not be enough for treatment. Risk factors for cervical cancer include a history of multiple sexual partners and unprotected intercourse, the age of sexual debut, smoking, neglecting to screen, and also ethnic background (Bowyer, Dodd, Marlow, & Waller, 2014). However, none of these factors are grounds to assume a high likelihood of cervical cancer. Sometimes, unknown genetic issues or family history may contribute to the development of this disease.

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Watching for symptoms that may belong to the clinical manifestations of cervical cancer is essential. People who are later diagnosed with cervical cancer often initially report such chief complaints as vaginal bleeding after sexual intercourse or between periods, pelvic pain, unexplained pain during intercourse, or vaginal discharge that does not have a clear explanation. However, in many cases, women are not able to recognize the first symptoms of cervical cancer and continue living with such a serious threat to their reproductive system and their health.

Assessments of cervical cancer are based on the identification of risk factors and the evaluation of current symptoms and signs. Today, many women around the world do not know about the importance of being vaccinated against HPV. As a rule, girls aged between 12 and 13 years are provided with free HPV vaccination as a part of their school-based programs in different countries, with a possibility of avoiding cervical cancer in more than 80% of cases (Bowyer et al., 2014). Pap tests have to be regularly conducted to detect potentially dangerous conditions in the cervix. This method helps to prevent the growth of cancerous cells and remove damaged areas with little risk.

Diagnostic Studies and Laboratories

Nowadays, researchers, doctors, and healthcare workers focus on the development of diagnostic methods and laboratory analyses that are effective and easy to administer to help patients identify the stage and type of cervical cancer. Though Pap tests are used to screen for the disease and prevent its development, it is also a part of a diagnosis that can be offered to patients (Centers for Disease Control and Prevention, 2013). A doctor has to scrape cell samples from the cervix and investigate if there have been any changes. As soon as the results of the Pap tests indicate the presence of changes or anomalies, continuing with the diagnosis is required and several more steps must be taken. Fang et al. (2014) describe the HPV DNA test as one of the best triage tests, with a 60% possibility of identifying atypical squamous cells in the cervix. It is recommended that women over 30 years of age take this test even if Pap test results are negative. Both these tests belong to the first stage of diagnosis for patients with cervical cancer.

The second stage of diagnosis includes a thorough physical examination, biopsy, and several imaging tests such as a CT scan, MRI, or X-rays. Colposcopy is one of the most frequent diagnostic methods used to examine the condition of the cervix and identify if visual changes have occurred there. This procedure helps to examine the damaged area and obtain a sample for further analysis. The cervical tissue has to be properly investigated in laboratories to clarify the nature of any changes or growth that may have occurred. When the analysis of the tissue indicates cervical cancer, doctors may recommend taking new tests and paying attention to a general image. Computed tomography, ultrasonography, and magnetic resonance imaging can be conducted to improve the clinical image of cervical cancer (Amaro-Filho et al., 2013). As soon as doctors observe the cervix, clinical management and treatment can be developed.

Clinical Management and Treatment

Several factors contribute to defining the method of treatment and clinical management. First, the patient should be informed about the stage of cervical cancer (if it is a stage I, II, III, or IV, depending on the area where cancer is present at the moment). Second, the patient may have additional health problems like diabetes, respiratory diseases, or allergies. For the early stages of cervical cancer, radiotherapy, or surgery known as hysterectomy can be offered as the main treatment method (Amaro-Filho et al., 2013). The removal of the uterus can be an effective method to prevent a recurrence. Still, women should understand that this operation leads to the inability to become pregnant in the future. Radiotherapy is based on the use of high-powered energy rays with whose help it is possible to kill cancer cells and prevent its recurrence. Clinical management of radiotherapy depends on the patient’s desire to have children or not. If a woman has a positive answer to childbirth plans and wants to preserve her options for the future, special steps should be taken to protect her eggs and minimize damage.

Chemotherapy is another treatment modality that is offered to patients who have stage III or IV cancer. It entails the injection of medications into the veins. As a rule, doctors recommend this method along with radiotherapy. Surgery is not necessary for those patients who undergo chemotherapy, as this stage of cancer is usually not curable. These steps are taken to reduce the level of pain and prolong the patient’s life to the greatest possible extent. Many patients interrupt this treatment because they do not want to spend their money or waste their time on treatment that cannot lead to positive results. They will often break off any communication with doctors and prioritize their demands and needs.

Evaluation of Treatments

The evaluation of treatments available to patients with cervical cancer is an integral part of the analysis of its pathophysiological processes and its impact on the quality of human life. On the one hand, the goal of each treatment modality is to help patients, decrease their level of pain, reduce suffering, and provide hope. On the other hand, the choice of treatment may be interpreted by patients in many different ways. Patients and their families may lose hope and start believing that death is the only outcome that can be expected. Doctors may seek to avoid the necessity of making final decisions. Medical researchers and scientists may realize that they have not attempted all options yet, and their contribution to science and medicine may be improved.

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Taking into consideration past research, there are three main types of treatment: surgery, radiotherapy, and chemotherapy. Each type has to be taken into consideration depending on the level of cancer the patient has. If there is a possibility to remove a tumor and thereby eliminate any chance of recurrence, doctors recommend surgery. If there is a chance that cancer may return, patients should use radiotherapy in addition to a surgical strategy. Surgery strategies may be simple (when the cervix or the uterus damaged by a tumor can be removed) or radical (when a part of the vagina or lymph nodes have to be removed because of being damaged by cancer cells). Still, despite the type of surgery, many patients accept this treatment positively, as it offers a chance to have a long life and avoid cancer complications (apart from the inability to bear a child). In cases where surgery is not considered an effective treatment method, patients must understand that chemotherapy is not a treatment method that can promise a cure. It only offers a possibility to reduce suffering and extend life by as much time as possible.

Patient Education and Safety

Treatment of cervical cancer can be improved if patients and their families are properly informed about prevention and treatment. In the United States, Quality and Safety Education for Nurses (QSEN) projects have been developed to prepare nurses to take care of patients with cancer. QSEN provides a chance to improve knowledge, develop skills, and create special attitudes, with an overarching goal of improving the quality of health care. Safety is one of the QSEN competencies that have to be promoted among nurses. It is necessary to extend this list by adding teamwork and collaboration (nurses should know whom they can address if they need professional support), patient-centered care (nurses understand the core of their responsibilities), evidence-based practice (nurses can combine their personal experience with scientific theories), and quality improvement (nurses can strive for new achievements and changes).

In addition to properly organized training programs for nurses and healthcare workers, attention should be paid to patient education. People who have to live with cervical cancer, have a chance to be treated for this disease, or want to know how to prevent cancer should be properly educated. First, they should understand that sexual relationships must be safe and protected. It is recommended to avoid multiple partners and check the physical condition of both parties. Second, patients have to be educated about the importance of regular screening and check-ups at different ages. Not all girls are informed about HPV vaccination and Pap testing. Education is a chance to help women understand how they can protect themselves against cervical cancer. Finally, cooperation with doctors and monitoring of female health cannot be ignored. If cervical cancer is not a genetic problem, it can be solved and prevented. Women should be aware of their options and make use of all opportunities.

Case Study Discussion

The chosen case study introduces a 50-year-old female with abdominal pain and vaginal bleeding. She is not aware of cervical cancer is a family problem because she was adopted, with no available information about her genetic family. Still, she is a smoker, which can be a serious risk factor for cancer. In light of these conditions, including her age and the area of pain, it is necessary to conduct a colposcopy, take a cell sample from the cervix, conduct a Pap test, and use a CT scan to check the condition of the uterus. As soon as the presence or absence of HPV is proved, treatment and management should be developed as appropriate to the stage of the disease and the results of a physical examination of the patient. Education and safety issues may include communication about the negative outcomes of smoking and the necessity of paying special attention to sexual relationships, undergoing regular screening, and having check-ups.

Conclusion

Cervical cancer is a serious disease that may take human lives in a short period because its signs and symptoms are not always easily recognized. Some groups of women, including those who are older, who smoke, or who have multiple sexual partners, are at elevated risk of developing this type of cancer. Its pathophysiology has been analyzed by many researchers and scientists to provide patients and healthcare workers with a chance to improve treatment and prevent complications. Regardless of their social status, education, or area of residence, women should remember to have regular tests and screening and choose vaccination against HPV as the main cause of cervical cancer. If there is a chance to avoid cancer, women should not neglect it.

Reference List

Amaro-Filho, S.M., Golub, J. E., Nuovo, G. J., Cunha, C. B., Levi, J. E., Villa, L. L.,… Nicol, A. F. (2013). A comparative analysis of clinical and molecular factors with the stage of cervical cancer in a Brazilian cohort. PLoS One, 8(3), 1-10. Web.

Bowyer, H.L., Dodd, R.H., Marlow, L.A.V., & Waller, J. (2014). Association between human papillomavirus vaccine status and other cervical cancer risk factors. Vaccine, 32(34), 4310-4316.

Centers for Disease Control and Prevention. (2013). Cervical cancer screening among women aged 18-30 years – United States, 2000-2010. Morbidity and Mortality Weekly Report, 61(51-52), 1038-1042.

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Fang, J., Zhang, H., & Jin, S. (2014). Epigenetics and cervical cancer: From pathogenesis to therapy. Tumor Biology, 35(6), 5083-5093.

McCance, K.L., Huether, S.E., Brashers, V.L., & Rote, N.S. (Eds.). (2015). Pathophysiology: The biological basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby Elsevier.

Pierangelo, A., Nazac, A., Benali, A., Validire, P., Cohen, H., Novikova, T., … Martino, A.D. (2013). Polarimetric imagining of uterine cervix: A case study. Optics Express, 21(12), 14120-14130.

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StudyCorgi. (2020, December 15). Cervical Cancer: Pathophysiological Processes. Retrieved from https://studycorgi.com/cervical-cancer-pathophysiological-processes/

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