A. Definition
Circumstances in which the cells neolpastik found in all layers of the epithelium. Pre-cancerous changes that are not up to the entire epithelial layer meligatkan called cervical dysplasia is divided into mild, moderate and severe. Intraepithelial neoplasia cervical dysplasia is (CIN), its level was CIN 1 (mild dysplasia) CIN 2 (dysplasia moderate) and CIN 3 (severe dysplasia and carcinoma in situ).
B. Etiology
With certainty the cause is unknown, but generally suffered by women with advanced age, sometimes in younger women, are also common in multi-gravida with've given birth four times or more, the incidence is higher in women who have married non aripada mating, especially at first coitus girl at a very young age (<16 years), rarely found in virgin (virgo), the incidence increased with higher parity, especially if birth spacing is too close, they were from lower socioeconomic groups (poor sexual hygiene , sexual activities that have multiple sexual partners), rarely found in people whose husbands have circumcision, often found in women who mengalai Human Papilloma Virus (HPV) types 16 or 18, women who smoke also have a big risk.
C. Signs and symptoms
In early cervical cancer perkembangannnya not provide signs and complaints, on examination with a speculum looks as porsio the erosive (squamous metaplasia) of physiological or patologik.Keputihan a symptom that is often found, more and more foul smelling a result of infection and tissue necrosis. Perdarahah experienced soon after intercourse (contact bleeding) is a symptom of cervical carcinoma (75-80%). Spontah Bleeding can also occur, generally at a more advanced level clinics (II or III), especially in tumors that would accompany eksofitik.Anemia as a result of recurrent vaginal bleeding. Pain may also arise as a result of infiltration of tumor cells to nerve fibers.
D. Pathophysiology
There are no specific signs and symptoms of this disease, bleeding is the only obvious symptom, but often does not occur early in the disease so that the cancer has lamjut when found.
CIN is usually found in connection with the squamous epithelium of the mucosal columnar endocervical epithelium.
Invasive cervical carcinoma occur if the tumor penetrates the epithelium into the cervical stroma, invasion can occur in several places at once in which tumor cells spread into the connective tissue and eventually penetrate the lymphatic vessels and veins. Invasive cervical carcinoma can invade or spread to the vaginal wall, cardiac ligament and the endometrial cavity; invasion into lymph vessels and blood vessels can lead to metastasis to distant places.According Federatrion Internationale de Gynecologic et Obstretique (FIGO) stage cervical carcinomas are divided into:
Pre-invasive carcinoma- 0 is carcinoma in situ, intraepithelial carcinoma
Invasive carcinoma- I carcinoma confined to the cervix- II carcinoma cervix extends down but not up to the pelvic wall; involves a two-thirds of the vagina- III carcinoma extends to the pelvic wall; involves the lower third of vagina- IV carcinoma extends to the mucosa of the bladder and rectumWhile the degree of malignancy clinic according to FIGO, 1978 are as follows:Level Criteria0 Carcinoma In Situ or intraepithelial carcinoma: basal membrane was still intact.I process confined to the cervix, although there is an extension to the corpus uteri.He carcinoma mikriinfasif; when the membrane is damaged basals and stromal tumor cells have entered not> 3mm, and there are no tumor cells in blood vessels or vessels limpe.*) Infasi depth of 3 mm should be replaced with not> 1 mm.OCC Ib: (Ib lb occult = hidden); clinically tumor is not visible as a carcinoma, but on histological examination of tumor cells it has entered into stromal invasion more than he.Ib Clinically there was to be expected that histological tumor showed invasion into the cervix uteri stoma.Process II was out of setrviks malignancies and metastasized to ⅔ of the vagina and / to the parametrial, but not until the pelvic wall.IIa spread only to the vagina, parametrial infiltrates remained free of tumor.The spread to the parametrial IIb, uni / bilateral, but not to the pelvic wallIII The spread is up to ⅓ of the distal vagina or the parametrial to the pelvic wall.IIIa Spreading up to ⅓ of the distal vagina, while the parametrial undisputed origin is not up to the pelvic wall.Spread IIIb is up to the pelvic wall, no infiltration was found between tumor-free area with a wall of the pelvis (pelvic frozen) or the process at the clinic level I or II, but there have been impaired renal physiology.IV The process of malignancy has been out of the small pelvis and involving the rectal mucosa and / or bladder (proved by histological), or metastasis has occurred outside the pelvis or to distant places.IV The process was out of the small pelvis, or had infiltrated the rectal mucosa and / bladder.IVb has spread far
With the level of malignancy TNM system can be divided into:
Level CriteriaT Not found the primary tumor.T1s pre-invasive carcinoma, is KIS (Carcinoma In Situ).T1 carcinoma confined to the cervix, (although the extension to corpus uteri)Pre-clinical T1a carcinoma menginvasif is evidenced by histological examination.T1b Clinically apparent invasive carcinoma.T2 carcinoma has expanded beyond the cervix, but has not reached the pelvic wall, or carcinoma had metastasized to the vagina, but at not reached the distal.T2a carcinoma has not menginviltrasi parametrial.T2b carcinoma has menginviltrasi parametrial.T3 carcinoma has involved the distal ⅓ vagina or has reached the pelvic wall (there is no gap between tunor free and pelvic wall).NB: The presence of hydronephrosis or renal physiology gangguna ureter due to stenosis due to tumor infiltration, causing the case is considered as T3 although in other cases the discovery was supposed to get a lower category (T1 or T2).T4 has menginviltrasi mucosal carcinoma of the bladder or rectum or extends beyond the pelvis. (Found bullosa edema is not sufficient evidence to classify as T4).T4a carcinoma involving the bladder or rectum and proven histological course.T4b carcinoma has expanded beyond the pelvis.NB: Enlargement of the uterus have no reason to include it as T4.NX If it is not possible to assess regional limphe gland. Signs - / + ditambahan for tamgahan there / no information regarding its histological examination, thus: NX NX + or -.N0 absence of deformity Dapa limphe gland lymphography.N1 regional lymph limphe change shape as shown by the diagnostic methods available (eg, lymphography, CT-scan of the pelvis)N2 palpable solid mass and attached to the pelvic wall with free gap between the infiltrates in these tumors.M0 No distant metastasis.There M1 distant metastasis, including glands limphe above the bifurcation of the iliac arteries.
E. Possible complications
Possible complications that can be experienced by clients with carsinoma uteri is the occurrence of metastases of malignant cells into the vaginal wall, ligament kardinale, endometrial cavity and to other organs / to distant places, bleeding, renal failure (CRF: Cronic renal failure) result of tumor infiltration into the ureter before entering the bladder, causing total obstruction.
F. Medical management1. Diagnosis
Pap smear performed for screening to detect neoplastic changes. The results of the abnormal smear followed by a biopsy to obtain tissue for examination sitologik. Cervical because they usually appear normal colposcopy then used a tool to guide the actions of abnormal biopsy on the area to take samples. Needle biopsy in the disorders of Regional or cone biopsy on the entire squamocolumnar junction was also conducted.2. Handling
Early stages of CIN can be done entirely with the appointment of a cone biopsy, or cleaned with a laser, cautery or with surgical frozen, further actions are organized and often carried out to monitor the recurrence of the lesion needs to be done after treatment with these ways.
At the clinical level (KIS) is not allowed to do electrocoagulation or elektrofulgerasi, krio surgery (cryosurgery) or with a beam of LASE, except when the handle is an expert in colposcopy and sufferers are young and have not had children.
If the woman is planning to have no more children, then the chosen treatment with hysterectomy followed by periodic follow-up examination and a Pap smear.
Handling of invasive cervical carcinoma can be either radiotherapy or radical hysterectomy with remove the uterus, tubes, ovaries, ats-third of the vagina and pelvic lymph nodes, if lymph nodes are also affected aortic chemotherapy is also required. Prognosis after treatment for cervical cancer would be better if the lesion is found and treated early, can cure expectancy reached 85% for stage I, 50% -50% for stage II, 30% for stage III and 50-10% for stage IV .
In certain cases where surgery is contraindicated, the application of radium with a dose of 6500-7000 rads / cGy at point A (2 cm from oue and as far as 2 cm from the axis of the uterus) without the addition of external radiation can be done.
He was at the clinic level, is generally regarded and treated as an invasive cancer, when the invasive depth of less than or only 1 mm and does not cover a large area and does not involve blood or lymph vessels, penangananya performed as in KIS above.At the clinic Ib. Ib OCC. And IIa hysterectomy with lymphadenectomy panngul tadikal. Post-surgical radiation is usually followed, depending on the presence / absence of tumor cells in regional lymph glands are removed.At level IIB, III, and IV are not justified to surgery, for this is the primary radiotherapy. Should be the case with cervical carcinoma as soon as sent to the central handling of cancer.
At the clinic level IVa and IVb are only palliative radiation. Giving khemotherapi can dipertimbangakan. In recurrent disease one year after comprehensive treatment can be performed if surgery and radiation therapy is the previous process is still limited to match the pelvis, when the process is already far or impossible dilakuakn surgery, chemotherapy should be selected if the conditions are met, this can not be used for single sitostastika but form of a combination regimen consisting of several sitostatica (polokhemoterapi). If the previous therapy was surgery should be performed when the process is still limited exposure in the pelvis (lokoregional), whereas if the radiation does not allow or distribution process is advanced in the selected polikhemoterapi when the conditions are met.3. ChemotherapyIs a form of cancer treatment using drugs sitostatika ie a substance that can inhibit proliferation of cancer cells.a. The working principle of chemotherapy drugs (sitostatica) against cancer.Most chemotherapy drugs (sitostatica) used currently working mainly on cancer cells that are proliferating, actively growing cancer cells proliferate, the more sensitive sitostatica Kemoresponsif this is called, otherwise the slower prolifersainya then the lower the sensitivity, it This is called Kemoresisten.There are several kinds of chemotherapy drugs, which are:1) Drug class of alkylating agents, platinum Compouns, and anthracyclines obst golongsn Antibiotics work by, among others, bind to DNA in cell nuclei, so that the cells can not replicate.2) antimetabolite drugs, works directly on the molecular bases the cell nucleus, resulting in inhibiting DNA synthesis.3) topoisomerase-inhibitor drugs, Vinca alkaloids, and taxanes to work on the formation of tubulin disruption, resulting in mitotic cell barriers.4) drugs such as enzyme, L-asparaginase works by inhibiting protein synthesis, causing bottlenecks in the synthesis of DNA and RNA from these cancer cells.
b. Patterns of chemotherapy1) Induction ChemotherapyIntended to quickly shrink the tumor mass or the number of cancer cells, malignant Tomur example in a large (bulky tumor mass) or in blood malignancies such as leukemia or lymphoma, also called rescue medication.2) adjuvant chemotherapyUsually given after other treatments such as surgery or radiation, the goal is to destroy cancer cells remaining or existing small metastases (micro metastasis).3) Primary ChemotherapyIntended as a primary treatment in malignant tumors, given that cancer is chemosensitive, usually given before other treatments such as surgery or radiation.4) Neo-adjuvant ChemotherapyGiven preceding / pre-treatment / other measures such as surgery or radiation followed by more chemotherapy. The goal is to shrink a large tumor mass so that surgery or radiation will be more effective.c. The way the chemotherapy drug delivery.1) Intra-venous (IV)Most sitostatica given in this way, can be either IV bolus slowly about 2 minutes, can also be a drip IV of about 30-120 minutes, or by continuous drip infusion of approximately 24 hours with efforts to pump more accurate drops.2) Intra tekal (IT)Administered into the spinal cord canal to destroy tumors in the cerebrospinal fluid (liquor cerebrospinalis), among others, MTX, Ara.C.3) Radiosensitizer, which is a type of chemotherapy given before radiation, the aim to strengthen the effects of radiation, chemotherapy drugs, among other untukl Fluoruoracil, cisplatin, Taxol, Taxotere, Hydrea.4) OralOral administration is usually the drug Leukeran ®, Alkeran ®, Myleran ®, Natulan ®, Puri-netol ®, hydrea ®, Tegafur ®, Xeloda ®, Gleevec ®.5) Subcutaneous and intramuscularThe provision of sub-cutaneous've very rarely done, usually the L-asparaginase, this is often avoided because of the risk of anaphylactic shock. Giving per IM has also been rarely performed, usually giving Bleomycin.6) Topical7) Intra arterial8) Intracavity9) Intraperitoneal / IntrapleuralWhen the production of fluid administered intraperitoneally acites hemoragis that much on intra-abdominal malignant cancer, including cisplatin. Provision is given into the intrapleural cavity pleuralis to destroy cancer cells in pleural fluid or pleural effusion production mengehntikan hemoragis very much, for example Bleocin.d. The goal of chemotherapy.1) Treatment.2) Reducing the tumor mass in addition to surgery or radiation.3) Improving the survival and improve quality of life.4) Reduce the complications caused by metastases.
e. Preparation and Conditions of chemotherapy.1) PreparationBefore pengotan started the first examination that includes:a) Blood banks; Hb, Leuko, count type, Platelets.b) liver function; bilirubin, SGOT, SGPT, Alkaline Phosphate.c) Renal function; U +, creatinine and creatinine clearance test when serim creatinine increase.d) an audiogram (especially in the provision of Cis-plastinum)e) ECG (especially the provision of Adriamycin, epirubicin).2) Termsa) The general condition is good enough.b) Patients understand the purpose and side effects will occur, informed concent.c) Physiology of kidney and liver either.d) pathologic diagnosise) The type of cancer known to be sensitive enough to chemotherapy.f) History of treatment (radiotherapy / chemotherapy) before.g) Laboratory tests showed hemoglobin> 10 g%, leukocyte count> 5000 / mm ³, platelets> 150 000/mm ³.f. Side effects of chemotherapy.Generally, side effects of chemotherapy consisting of:1. Amping effects occur immediately (Immediate Side Effects) arising in the first 24 hours of delivery, such as nausea and vomiting.2. Side effects that occur early (Early Side Effects) arising within a few days to several weeks later, for example netripenia and stomatitis.3. Side effects that occurred later (Delayed Side Effects) arising within a few days to several months, such as peripheral neuropathy, neuropathy.4. Side effect that occurred later (Late Side Effects) arising within a few months to years, such as secondary malignancies.
The intensity of side effects depends on the characteristics of the drug, the dose at each administration, as well as cumulative dose, in addition to side effects that occur in every patient is different though with the same doses and drugs, nutrition and psychological factors also have significant influence.
Side effects are almost always encountered were gastrointestinal symptoms, bone marrow suppression, hair loss. The main gastrointestinal symptoms are nausea, vomiting, diarrhea, constipation, pharyngitis, esophagitis and mukositis, nausea and vomiting usually occur after a long time after administration sitostatica dab lasts no more than 24 hours.
Symptoms of bone marrow suppression, especially the decline in the number of white blood cells (leukopenia), platelet cells (thrombocytopenia), and red blood cells (anemia), bone marrow suppression resulting from the furnishing sitistatika may occur immediately or later, the bone marrow suppression that occurs immediately, decreased levels of leukocytes reaching the lowest value on day 8 to day 14, after that it takes about 2 days to raise the levels laukositnya back. In bone marrow suppression that occurs later decreased levels of leukocytes occurs twice: first of all in the second week and at about week four and five. Leukocyte levels then rose again and will reach a value close to normal in the sixth week. Leukopenia can lower body power, thrombocytopenia may lead to persistent bleeding / berlabihan if there is erosion in the gastrointestinal tract.
Hair loss can vary from mild hair loss baldness dampai on. side effects are rare but no less important is heart muscle damage, sterility, pulmonary fibrosis, kidney damage, liver damage, skin sclerosis, anaphylactic reactions, neurological disorders, hormonal disorders, and genetic changes that can lead to the occurrence of new cancers.
Cardiomyopathy due to doksorubin and daunorubicin are generally difficult to overcome, most patients die of "pump failure", commonly iireversibel pulmonary fibrosis, liver abnormalities occur usually further complicate the provision sitistatika because many of them are metabolized in the liver, side effects on the skin, nerves, uterus and gastrointestinal urine is relatively small and more easily overcome.
G. Nursing diagnoses that may ariseNursing diagnoses that may arise are:1. Acute pain associated with actual or potensual tissue damage caused by tumor metastases.2. Anxiety associated with changes in health status3. Activity intolerance bd fatigue, malnutrition, drop in mobility4. Imbalance nutrition: less than body requirements regarding premises bd hypermetabolic status of cancer.5. The risk of infection secondary defense ketidakadekuatan bd
BibliographyBulecheck, 1996, the Nursing Intervention Classification (NIC), Mosby-Year Book, USANanda, 2001, Nursing Diagnoses Definitions and Classification, PhiladelphiaPrice & Wilson, 1995, Concept of Clinical Pathophysiology Disease Processes, EGC, Jakarta.Saifudin, A. et al, 2002, Practical Handbook for Maternal and Neonatal Health Services, YBP-SP, Jakarta.Wiknjosastro, H. et al, 2002, Obstetrics, YBP-SP, Jakarta.Wiknjosastro, H.dkk, 1999, Science content, YBP-SP, Jakarta.WwwI.Us.Elsevierhealth.Com, 2004, the Nursing Diagnosis: A Guide to Planning Care, fifth Edition.
Circumstances in which the cells neolpastik found in all layers of the epithelium. Pre-cancerous changes that are not up to the entire epithelial layer meligatkan called cervical dysplasia is divided into mild, moderate and severe. Intraepithelial neoplasia cervical dysplasia is (CIN), its level was CIN 1 (mild dysplasia) CIN 2 (dysplasia moderate) and CIN 3 (severe dysplasia and carcinoma in situ).
B. Etiology
With certainty the cause is unknown, but generally suffered by women with advanced age, sometimes in younger women, are also common in multi-gravida with've given birth four times or more, the incidence is higher in women who have married non aripada mating, especially at first coitus girl at a very young age (<16 years), rarely found in virgin (virgo), the incidence increased with higher parity, especially if birth spacing is too close, they were from lower socioeconomic groups (poor sexual hygiene , sexual activities that have multiple sexual partners), rarely found in people whose husbands have circumcision, often found in women who mengalai Human Papilloma Virus (HPV) types 16 or 18, women who smoke also have a big risk.
C. Signs and symptoms
In early cervical cancer perkembangannnya not provide signs and complaints, on examination with a speculum looks as porsio the erosive (squamous metaplasia) of physiological or patologik.Keputihan a symptom that is often found, more and more foul smelling a result of infection and tissue necrosis. Perdarahah experienced soon after intercourse (contact bleeding) is a symptom of cervical carcinoma (75-80%). Spontah Bleeding can also occur, generally at a more advanced level clinics (II or III), especially in tumors that would accompany eksofitik.Anemia as a result of recurrent vaginal bleeding. Pain may also arise as a result of infiltration of tumor cells to nerve fibers.
D. Pathophysiology
There are no specific signs and symptoms of this disease, bleeding is the only obvious symptom, but often does not occur early in the disease so that the cancer has lamjut when found.
CIN is usually found in connection with the squamous epithelium of the mucosal columnar endocervical epithelium.
Invasive cervical carcinoma occur if the tumor penetrates the epithelium into the cervical stroma, invasion can occur in several places at once in which tumor cells spread into the connective tissue and eventually penetrate the lymphatic vessels and veins. Invasive cervical carcinoma can invade or spread to the vaginal wall, cardiac ligament and the endometrial cavity; invasion into lymph vessels and blood vessels can lead to metastasis to distant places.According Federatrion Internationale de Gynecologic et Obstretique (FIGO) stage cervical carcinomas are divided into:
Pre-invasive carcinoma- 0 is carcinoma in situ, intraepithelial carcinoma
Invasive carcinoma- I carcinoma confined to the cervix- II carcinoma cervix extends down but not up to the pelvic wall; involves a two-thirds of the vagina- III carcinoma extends to the pelvic wall; involves the lower third of vagina- IV carcinoma extends to the mucosa of the bladder and rectumWhile the degree of malignancy clinic according to FIGO, 1978 are as follows:Level Criteria0 Carcinoma In Situ or intraepithelial carcinoma: basal membrane was still intact.I process confined to the cervix, although there is an extension to the corpus uteri.He carcinoma mikriinfasif; when the membrane is damaged basals and stromal tumor cells have entered not> 3mm, and there are no tumor cells in blood vessels or vessels limpe.*) Infasi depth of 3 mm should be replaced with not> 1 mm.OCC Ib: (Ib lb occult = hidden); clinically tumor is not visible as a carcinoma, but on histological examination of tumor cells it has entered into stromal invasion more than he.Ib Clinically there was to be expected that histological tumor showed invasion into the cervix uteri stoma.Process II was out of setrviks malignancies and metastasized to ⅔ of the vagina and / to the parametrial, but not until the pelvic wall.IIa spread only to the vagina, parametrial infiltrates remained free of tumor.The spread to the parametrial IIb, uni / bilateral, but not to the pelvic wallIII The spread is up to ⅓ of the distal vagina or the parametrial to the pelvic wall.IIIa Spreading up to ⅓ of the distal vagina, while the parametrial undisputed origin is not up to the pelvic wall.Spread IIIb is up to the pelvic wall, no infiltration was found between tumor-free area with a wall of the pelvis (pelvic frozen) or the process at the clinic level I or II, but there have been impaired renal physiology.IV The process of malignancy has been out of the small pelvis and involving the rectal mucosa and / or bladder (proved by histological), or metastasis has occurred outside the pelvis or to distant places.IV The process was out of the small pelvis, or had infiltrated the rectal mucosa and / bladder.IVb has spread far
With the level of malignancy TNM system can be divided into:
Level CriteriaT Not found the primary tumor.T1s pre-invasive carcinoma, is KIS (Carcinoma In Situ).T1 carcinoma confined to the cervix, (although the extension to corpus uteri)Pre-clinical T1a carcinoma menginvasif is evidenced by histological examination.T1b Clinically apparent invasive carcinoma.T2 carcinoma has expanded beyond the cervix, but has not reached the pelvic wall, or carcinoma had metastasized to the vagina, but at not reached the distal.T2a carcinoma has not menginviltrasi parametrial.T2b carcinoma has menginviltrasi parametrial.T3 carcinoma has involved the distal ⅓ vagina or has reached the pelvic wall (there is no gap between tunor free and pelvic wall).NB: The presence of hydronephrosis or renal physiology gangguna ureter due to stenosis due to tumor infiltration, causing the case is considered as T3 although in other cases the discovery was supposed to get a lower category (T1 or T2).T4 has menginviltrasi mucosal carcinoma of the bladder or rectum or extends beyond the pelvis. (Found bullosa edema is not sufficient evidence to classify as T4).T4a carcinoma involving the bladder or rectum and proven histological course.T4b carcinoma has expanded beyond the pelvis.NB: Enlargement of the uterus have no reason to include it as T4.NX If it is not possible to assess regional limphe gland. Signs - / + ditambahan for tamgahan there / no information regarding its histological examination, thus: NX NX + or -.N0 absence of deformity Dapa limphe gland lymphography.N1 regional lymph limphe change shape as shown by the diagnostic methods available (eg, lymphography, CT-scan of the pelvis)N2 palpable solid mass and attached to the pelvic wall with free gap between the infiltrates in these tumors.M0 No distant metastasis.There M1 distant metastasis, including glands limphe above the bifurcation of the iliac arteries.
E. Possible complications
Possible complications that can be experienced by clients with carsinoma uteri is the occurrence of metastases of malignant cells into the vaginal wall, ligament kardinale, endometrial cavity and to other organs / to distant places, bleeding, renal failure (CRF: Cronic renal failure) result of tumor infiltration into the ureter before entering the bladder, causing total obstruction.
F. Medical management1. Diagnosis
Pap smear performed for screening to detect neoplastic changes. The results of the abnormal smear followed by a biopsy to obtain tissue for examination sitologik. Cervical because they usually appear normal colposcopy then used a tool to guide the actions of abnormal biopsy on the area to take samples. Needle biopsy in the disorders of Regional or cone biopsy on the entire squamocolumnar junction was also conducted.2. Handling
Early stages of CIN can be done entirely with the appointment of a cone biopsy, or cleaned with a laser, cautery or with surgical frozen, further actions are organized and often carried out to monitor the recurrence of the lesion needs to be done after treatment with these ways.
At the clinical level (KIS) is not allowed to do electrocoagulation or elektrofulgerasi, krio surgery (cryosurgery) or with a beam of LASE, except when the handle is an expert in colposcopy and sufferers are young and have not had children.
If the woman is planning to have no more children, then the chosen treatment with hysterectomy followed by periodic follow-up examination and a Pap smear.
Handling of invasive cervical carcinoma can be either radiotherapy or radical hysterectomy with remove the uterus, tubes, ovaries, ats-third of the vagina and pelvic lymph nodes, if lymph nodes are also affected aortic chemotherapy is also required. Prognosis after treatment for cervical cancer would be better if the lesion is found and treated early, can cure expectancy reached 85% for stage I, 50% -50% for stage II, 30% for stage III and 50-10% for stage IV .
In certain cases where surgery is contraindicated, the application of radium with a dose of 6500-7000 rads / cGy at point A (2 cm from oue and as far as 2 cm from the axis of the uterus) without the addition of external radiation can be done.
He was at the clinic level, is generally regarded and treated as an invasive cancer, when the invasive depth of less than or only 1 mm and does not cover a large area and does not involve blood or lymph vessels, penangananya performed as in KIS above.At the clinic Ib. Ib OCC. And IIa hysterectomy with lymphadenectomy panngul tadikal. Post-surgical radiation is usually followed, depending on the presence / absence of tumor cells in regional lymph glands are removed.At level IIB, III, and IV are not justified to surgery, for this is the primary radiotherapy. Should be the case with cervical carcinoma as soon as sent to the central handling of cancer.
At the clinic level IVa and IVb are only palliative radiation. Giving khemotherapi can dipertimbangakan. In recurrent disease one year after comprehensive treatment can be performed if surgery and radiation therapy is the previous process is still limited to match the pelvis, when the process is already far or impossible dilakuakn surgery, chemotherapy should be selected if the conditions are met, this can not be used for single sitostastika but form of a combination regimen consisting of several sitostatica (polokhemoterapi). If the previous therapy was surgery should be performed when the process is still limited exposure in the pelvis (lokoregional), whereas if the radiation does not allow or distribution process is advanced in the selected polikhemoterapi when the conditions are met.3. ChemotherapyIs a form of cancer treatment using drugs sitostatika ie a substance that can inhibit proliferation of cancer cells.a. The working principle of chemotherapy drugs (sitostatica) against cancer.Most chemotherapy drugs (sitostatica) used currently working mainly on cancer cells that are proliferating, actively growing cancer cells proliferate, the more sensitive sitostatica Kemoresponsif this is called, otherwise the slower prolifersainya then the lower the sensitivity, it This is called Kemoresisten.There are several kinds of chemotherapy drugs, which are:1) Drug class of alkylating agents, platinum Compouns, and anthracyclines obst golongsn Antibiotics work by, among others, bind to DNA in cell nuclei, so that the cells can not replicate.2) antimetabolite drugs, works directly on the molecular bases the cell nucleus, resulting in inhibiting DNA synthesis.3) topoisomerase-inhibitor drugs, Vinca alkaloids, and taxanes to work on the formation of tubulin disruption, resulting in mitotic cell barriers.4) drugs such as enzyme, L-asparaginase works by inhibiting protein synthesis, causing bottlenecks in the synthesis of DNA and RNA from these cancer cells.
b. Patterns of chemotherapy1) Induction ChemotherapyIntended to quickly shrink the tumor mass or the number of cancer cells, malignant Tomur example in a large (bulky tumor mass) or in blood malignancies such as leukemia or lymphoma, also called rescue medication.2) adjuvant chemotherapyUsually given after other treatments such as surgery or radiation, the goal is to destroy cancer cells remaining or existing small metastases (micro metastasis).3) Primary ChemotherapyIntended as a primary treatment in malignant tumors, given that cancer is chemosensitive, usually given before other treatments such as surgery or radiation.4) Neo-adjuvant ChemotherapyGiven preceding / pre-treatment / other measures such as surgery or radiation followed by more chemotherapy. The goal is to shrink a large tumor mass so that surgery or radiation will be more effective.c. The way the chemotherapy drug delivery.1) Intra-venous (IV)Most sitostatica given in this way, can be either IV bolus slowly about 2 minutes, can also be a drip IV of about 30-120 minutes, or by continuous drip infusion of approximately 24 hours with efforts to pump more accurate drops.2) Intra tekal (IT)Administered into the spinal cord canal to destroy tumors in the cerebrospinal fluid (liquor cerebrospinalis), among others, MTX, Ara.C.3) Radiosensitizer, which is a type of chemotherapy given before radiation, the aim to strengthen the effects of radiation, chemotherapy drugs, among other untukl Fluoruoracil, cisplatin, Taxol, Taxotere, Hydrea.4) OralOral administration is usually the drug Leukeran ®, Alkeran ®, Myleran ®, Natulan ®, Puri-netol ®, hydrea ®, Tegafur ®, Xeloda ®, Gleevec ®.5) Subcutaneous and intramuscularThe provision of sub-cutaneous've very rarely done, usually the L-asparaginase, this is often avoided because of the risk of anaphylactic shock. Giving per IM has also been rarely performed, usually giving Bleomycin.6) Topical7) Intra arterial8) Intracavity9) Intraperitoneal / IntrapleuralWhen the production of fluid administered intraperitoneally acites hemoragis that much on intra-abdominal malignant cancer, including cisplatin. Provision is given into the intrapleural cavity pleuralis to destroy cancer cells in pleural fluid or pleural effusion production mengehntikan hemoragis very much, for example Bleocin.d. The goal of chemotherapy.1) Treatment.2) Reducing the tumor mass in addition to surgery or radiation.3) Improving the survival and improve quality of life.4) Reduce the complications caused by metastases.
e. Preparation and Conditions of chemotherapy.1) PreparationBefore pengotan started the first examination that includes:a) Blood banks; Hb, Leuko, count type, Platelets.b) liver function; bilirubin, SGOT, SGPT, Alkaline Phosphate.c) Renal function; U +, creatinine and creatinine clearance test when serim creatinine increase.d) an audiogram (especially in the provision of Cis-plastinum)e) ECG (especially the provision of Adriamycin, epirubicin).2) Termsa) The general condition is good enough.b) Patients understand the purpose and side effects will occur, informed concent.c) Physiology of kidney and liver either.d) pathologic diagnosise) The type of cancer known to be sensitive enough to chemotherapy.f) History of treatment (radiotherapy / chemotherapy) before.g) Laboratory tests showed hemoglobin> 10 g%, leukocyte count> 5000 / mm ³, platelets> 150 000/mm ³.f. Side effects of chemotherapy.Generally, side effects of chemotherapy consisting of:1. Amping effects occur immediately (Immediate Side Effects) arising in the first 24 hours of delivery, such as nausea and vomiting.2. Side effects that occur early (Early Side Effects) arising within a few days to several weeks later, for example netripenia and stomatitis.3. Side effects that occurred later (Delayed Side Effects) arising within a few days to several months, such as peripheral neuropathy, neuropathy.4. Side effect that occurred later (Late Side Effects) arising within a few months to years, such as secondary malignancies.
The intensity of side effects depends on the characteristics of the drug, the dose at each administration, as well as cumulative dose, in addition to side effects that occur in every patient is different though with the same doses and drugs, nutrition and psychological factors also have significant influence.
Side effects are almost always encountered were gastrointestinal symptoms, bone marrow suppression, hair loss. The main gastrointestinal symptoms are nausea, vomiting, diarrhea, constipation, pharyngitis, esophagitis and mukositis, nausea and vomiting usually occur after a long time after administration sitostatica dab lasts no more than 24 hours.
Symptoms of bone marrow suppression, especially the decline in the number of white blood cells (leukopenia), platelet cells (thrombocytopenia), and red blood cells (anemia), bone marrow suppression resulting from the furnishing sitistatika may occur immediately or later, the bone marrow suppression that occurs immediately, decreased levels of leukocytes reaching the lowest value on day 8 to day 14, after that it takes about 2 days to raise the levels laukositnya back. In bone marrow suppression that occurs later decreased levels of leukocytes occurs twice: first of all in the second week and at about week four and five. Leukocyte levels then rose again and will reach a value close to normal in the sixth week. Leukopenia can lower body power, thrombocytopenia may lead to persistent bleeding / berlabihan if there is erosion in the gastrointestinal tract.
Hair loss can vary from mild hair loss baldness dampai on. side effects are rare but no less important is heart muscle damage, sterility, pulmonary fibrosis, kidney damage, liver damage, skin sclerosis, anaphylactic reactions, neurological disorders, hormonal disorders, and genetic changes that can lead to the occurrence of new cancers.
Cardiomyopathy due to doksorubin and daunorubicin are generally difficult to overcome, most patients die of "pump failure", commonly iireversibel pulmonary fibrosis, liver abnormalities occur usually further complicate the provision sitistatika because many of them are metabolized in the liver, side effects on the skin, nerves, uterus and gastrointestinal urine is relatively small and more easily overcome.
G. Nursing diagnoses that may ariseNursing diagnoses that may arise are:1. Acute pain associated with actual or potensual tissue damage caused by tumor metastases.2. Anxiety associated with changes in health status3. Activity intolerance bd fatigue, malnutrition, drop in mobility4. Imbalance nutrition: less than body requirements regarding premises bd hypermetabolic status of cancer.5. The risk of infection secondary defense ketidakadekuatan bd
BibliographyBulecheck, 1996, the Nursing Intervention Classification (NIC), Mosby-Year Book, USANanda, 2001, Nursing Diagnoses Definitions and Classification, PhiladelphiaPrice & Wilson, 1995, Concept of Clinical Pathophysiology Disease Processes, EGC, Jakarta.Saifudin, A. et al, 2002, Practical Handbook for Maternal and Neonatal Health Services, YBP-SP, Jakarta.Wiknjosastro, H. et al, 2002, Obstetrics, YBP-SP, Jakarta.Wiknjosastro, H.dkk, 1999, Science content, YBP-SP, Jakarta.WwwI.Us.Elsevierhealth.Com, 2004, the Nursing Diagnosis: A Guide to Planning Care, fifth Edition.
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