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Reproductive & OB

Cervical & Ovarian Cancer

Cervical carcinoma High-yield Verified · Sep 2026

Cervical cancer is a cancer of the cervix caused almost entirely by human papillomavirus (HPV); epithelial ovarian cancer — grouped by NCI with fallopian tube and primary peritoneal cancer — arises in the tissue covering the ovary or lining the fallopian tube or peritoneum.

Cervical cancer follows persistent high-risk HPV through precancer (CIN) to invasion. So the nurse teaches HPV vaccine schedules and USPSTF screening intervals, and supports chemoradiation and brachytherapy with radiation-safety rules. Ovarian cancer is usually found late: the nurse takes persistent bloating, early satiety and pelvic pain seriously and knows CA-125 and ultrasound do not screen. Refer women with a strong family history for genetic counseling.

What’s going wrong in the body

The normal physiology, where it fails, and why the body’s compensation backfires.

01 [CERV] HPV → precancer → invasive cancer, slowly

"Cervical cancer, the fourth most common cancer among women worldwide, is caused almost entirely by human papillomavirus (HPV)." "High-risk types of HPV can lead to cervical intraepithelial lesions which, over time, can progress to cervical cancer." StatPearls: "More than 75% of cervical cancer cases are due to high-risk HPV types 16 and 18"; NCI: "subtypes 16 and 18 have been most closely associated with high-grade dysplasia and cancer." "HPV is transmitted by skin-to-skin contact, including during sexual intercourse, hand-to-genital contact, and oral sex."

Where it starts. "Cervical carcinoma begins at the squamocolumnar junction. It can involve the outer squamous cells, inner glandular cells, or both." The precursor is dysplasia — cervical intraepithelial neoplasia (CIN) or adenocarcinoma in situ — and "This process can be quite slow": NCI reports that 30% to 70% of untreated in situ lesions become invasive over 10 to 12 years, "However, in about 10% of patients, lesions can progress from in situ to invasive in less than 1 year." That slow window is why screening works.

Local spread. "Extension of the tumor in the cervix may ultimately manifest as ulceration, exophytic tumor, or extensive infiltration of underlying tissue, including the bladder or rectum." Spread to the pelvic side wall can block a ureter — staging includes "hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)."

High-risk HPV infection becomes precancer (CIN) and, usually over years, invasive cancer — vaccination blocks the first step and screening catches the slow middle step.

02 [OVAR] Early peritoneal spread, late symptoms

"Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer are diseases in which malignant (cancer) cells form in the tissue covering the ovary or lining the fallopian tube or peritoneum." They "form in the same type of tissue and are treated the same way." "High-grade serous carcinoma is the most common subtype of ovarian carcinoma," and "In 96% of high-grade serous subtypes, molecular testing demonstrates a TP53 mutation."

Ovulation and risk. "Factors that increase ovulation over a lifetime (eg, nulliparity, early menarche, or late menopause) are associated with increased ovarian cancer risk. However, the exact etiologic mechanism is not known." Factors that reduce ovulation lower risk — oral contraceptives, bilateral tubal ligation or salpingectomy, breastfeeding and multiparity. (Oral contraceptives lower ovarian risk; long-term use is a cervical-cancer risk factor with HPV.)

Why it is found late. The cancer spreads over the peritoneum before it causes distinct symptoms: "When signs or symptoms do appear, the cancer is often advanced," and StatPearls notes that "most patients are diagnosed at an advanced stage." Advanced disease brings "A palpable pelvic mass, ascites, or diminished breath sounds due to pleural effusions," and untreated women develop "ascites, bowel obstruction, pleural effusion, and bladder obstruction, apart from disorders of nutrition."

Epithelial ovarian cancer seeds the peritoneum early and causes only vague abdominal symptoms, so most cases are found after spread — ascites and obstruction come later.

03 Treatment logic — chemoradiation, brachytherapy and debulking

[CERV] Early disease may be treated surgically; for radical hysterectomy NCI notes "open abdominal surgery should be considered the standard of care for patients with early-stage cervical cancer who are candidates for radical hysterectomy." When radiation is needed, "Concurrent cisplatin-based chemotherapy with radiation therapy is the standard of care," and "The risk of death from cervical cancer was decreased by 30% to 50% with the use of concurrent chemoradiation therapy." "Standard radiation therapy for cervical cancer includes brachytherapy after external-beam radiation therapy (EBRT)." Timing matters: "Delay in radiation delivery completion is associated with poorer progression-free survival."

[BT] Brachytherapy puts the source inside the body. "Intracavity brachytherapy, in which the radiation source is placed within a body cavity or a cavity created by surgery. For example, radiation can be placed in the vagina to treat cervical or endometrial cancer." With a low-dose-rate (LDR) implant "the radiation source stays in place for 1 to 7 days" in hospital; with high-dose-rate (HDR) it "is left in place for just 10 to 20 minutes at a time and then taken out." While it is in, "the radiation source in your body will give off radiation for a while," which is why room and visitor rules apply — and why they stop once it is removed.

[OVAR] "Most patients have surgery to remove as much of the tumor as possible" — hysterectomy, bilateral salpingo-oophorectomy and omentectomy for advanced disease, ideally by "an experienced gynecologic oncologist." "Neoadjuvant chemotherapy followed by interval debulking surgery may be performed in patients deemed poor surgical candidates." Chemotherapy is platinum-based — StatPearls defines platinum sensitivity by the interval since the last "platinum-based chemotherapy cycle"; intraperitoneal (IP) chemotherapy carries drugs "directly into the peritoneal cavity," and PARP inhibitors (olaparib, rucaparib, niraparib) "may be used as maintenance therapy" for certain recurrent disease. "About 80% of women with advanced-stage ovarian cancer more commonly have tumor progression or recurrence."

While an LDR implant is in place the patient is a radiation source, so she has a private room and short, distanced visits with no pregnant or infant visitors; once the applicator is removed no radiation remains.

Causes & risk factors

Modifiable factors are teaching targets — the patient can act on them.

[CERV] Persistent high-risk HPV infection — "The primary risk factor for cervical cancer is human papillomavirus (HPV) infection." modifiable [CERV] Smoking (with HPV infection) modifiable [CERV] Immunosuppression — e.g., HIV; these women are outside the routine USPSTF screening recommendation and need individualized follow-up [CERV] Long-term oral contraceptive use (with HPV infection) and high parity (with HPV infection) [CERV] First sexual encounter at a young age; many sexual partners modifiable [CERV] In-utero diethylstilbestrol (DES) exposure [CERV] Not adequately screened — "Most cases of cervical cancer and related deaths occur among women who have not been adequately screened, followed up, or treated." modifiable [OVAR] More lifetime ovulation — nulliparity, early menarche, late menopause [OVAR] Hereditary syndromes (BRCA) — "Hereditary ovarian cancer makes up about 20% of all cases of ovarian cancer"; a family history of ovarian or breast cancer warrants a risk discussion

Signs & symptoms

Each finding tied to the mechanism that produces it — and the triage it calls for.

[CERV] Early disease — often no symptoms early
Why: "Early cervical cancer may not cause noticeable signs or symptoms" — the reason screening exists.
[CERV] Abnormal vaginal bleeding (after sex, between periods, after menopause) or unusual discharge Hold & notify
Why: A friable, ulcerated or exophytic cervical tumor bleeds; StatPearls lists "a friable cervix, visible cervical lesions, erosions, masses, bleeding with the examination" on exam. CDC: "If you have unusual vaginal bleeding, see a doctor right away."
[CERV] Postcoital bleeding and pain during intercourse Hold & notify
Why: StatPearls: the history should include "questions about postcoital bleeding and pain during intercourse."
[CERV] Hydronephrosis or a nonfunctioning kidney (advanced disease) late Hold & notify
Why: Tumor extending to the pelvic wall can obstruct urine flow — "hydronephrosis or nonfunctioning kidney" is part of stage III.
[OVAR] Bloating, feeling full quickly or difficulty eating, pelvic or abdominal pain or pressure, back pain, urgent or frequent urination, constipation Hold & notify
Why: Peritoneal tumor and ascites. CDC: "If you have any of the other signs for 2 weeks or longer and they are not normal for you, see a doctor." StatPearls: "most patients present with nonspecific symptoms."
[OVAR] Vaginal bleeding, especially after menopause Hold & notify
Why: Listed by CDC, but StatPearls notes "Abnormal uterine bleeding is not a common ovarian cancer symptom" — do not wait for it.
[OVAR] Ascites, pleural effusion, bowel or bladder obstruction (advanced disease) late Hold & notify
Why: Advanced peritoneal spread: "ascites, bowel obstruction, pleural effusion, and bladder obstruction." See the bowel-obstruction page for obstruction care.
[OVAR] Palpable pelvic mass; diminished breath sounds late
Why: StatPearls: "A palpable pelvic mass, ascites, or diminished breath sounds due to pleural effusions may also be found in advanced cases."

Diagnostics

Test In this disorder Normal
[SCR-C] Cervical screening, ages 21–29 Grade A. Cytology only before 30 because of "the high prevalence of transient HPV infection among adolescents and young adults." No screening before 21 (Grade D) — even if sexually active. Cytology (Pap) alone every 3 years USPSTF 2018 —
[SCR-C] Cervical screening, ages 30–65 Grade A. Stop after 65 with adequate prior screening and no high risk, and after hysterectomy with the cervix removed and no history of CIN 2/3 or cancer (Grade D) — "clinicians should confirm through review of surgical records or direct examination that the cervix was removed." Does not apply to women with high-grade lesions, cancer, in-utero DES or a compromised immune system (e.g., HIV). Cytology every 3 years, OR high-risk HPV test alone every 5 years, OR cotesting every 5 years USPSTF 2018 —
[SCR-C24] 2024 USPSTF DRAFT (not final) Draft dated December 10, 2024: "When finalized, this recommendation will update the 2018 USPSTF recommendation." Until finalized, the 2018 statement stands. HPV primary screening every 5 years from 30 as the preferred strategy — clinician- or patient-collected USPSTF 2024 draft —
[CERV] Colposcopy and biopsy "Colposcopy is the diagnostic procedure of choice"; "A diagnostic biopsy is needed to finalize the diagnosis." Precancer: cryotherapy or excision; conization, laser or LEEP for larger lesions. Conization complications: "hemorrhage, infection, cervical incompetence, cervical stenosis, and infertility." Confirms precancer or cancer after abnormal cytology or persistent high-risk HPV —
[SCR-O] Ovarian screening in average-risk women Grade D for asymptomatic women "not known to have a high-risk hereditary cancer syndrome." Screening harms include "many false-positive results, which can lead to unnecessary surgical interventions." Not recommended — CA-125, transvaginal ultrasound or both do not reduce deaths USPSTF 2018 —
[OVAR] Ultrasound, CT or PET (symptoms or mass) NCI lists an ultrasound exam (some patients have a transvaginal ultrasound), CT scan and PET scan among the tests used "to diagnose and stage" these cancers, with a pelvic exam and CA-125. Images the pelvis and abdomen —
[OVAR] CA-125 Not diagnostic. "CA-125 levels are increased in most advanced epithelial ovarian cancer cases but are elevated only in 50% of early-stage disease cases; therefore, the sensitivity of this biomarker is limited." "An increased CA-125 level can be a sign of cancer or another condition such as endometriosis." Tissue for diagnosis "is usually removed during surgery to remove the tumor." Raised in most advanced cases; raised in only about half of early cases —

Complications

Black-box warning — most severe: ■ [CRT] Hemorrhagic radiation cystitis — heavy hematuria with clots Report immediately
Chronic radiation cystitis after pelvic radiation brings blood in the urine. "The severity can range from mild to severe and life-threatening."
"A cystoscopy with clot evacuation and irrigation is necessary in more severe cases." "Any antiplatelet or anticoagulation medications the patient takes should be reviewed, and the necessity questioned."
Warning: [CRT] Radiation proctitis, vaginal stenosis, ovarian failure Hold & notify
"Radiation proctitis can result in tenesmus and intermittent bleeding with bowel movements." "Vaginal stenosis and vaginal canal shortening can develop over months to years after treatment." "Radiation-induced ovarian failure typically occurs within 6 to 12 months after radiation."
"Consistent use of a vaginal dilator is typically recommended; however, compliance is highly variable."
Warning: [TX] Platinum chemotherapy toxicity Hold & notify
"The most commonly used platinum-based drugs are cisplatin and carboplatin. Common adverse effects include neutropenia, thrombocytopenia, anemia, febrile neutropenia, nephrotoxicity, neurotoxicity, and infection."
Carboplatin can replace cisplatin when kidney disease makes cisplatin hard to tolerate. Fever during a neutropenic period — manage per the oncologic-emergencies page.
Warning: [CERV] Radical hysterectomy complications Hold & notify
"Complications include bleeding, infection, venous thromboembolism, pulmonary embolus, small bowel obstruction, vesicovaginal fistula, hydronephrosis, ureteral injury, urinary stress incontinence, and lower extremity edema."
Warning: [OVAR] Ascites, pleural effusion, bowel and bladder obstruction Hold & notify
Untreated or advanced disease causes "severe complications like ascites, bowel obstruction, pleural effusion, and bladder obstruction, apart from disorders of nutrition." End of life adds fatigue, nausea, vomiting, constipation and pedal edema.
Management of obstruction is on the bowel-obstruction page.
Warning: [TX] Bevacizumab adverse effects Hold & notify
Headache, epistaxis, hypertension, proteinuria, rhinitis, altered taste, skin changes and rectal hemorrhage; "The most severe adverse effects include gastrointestinal perforation, impaired wound healing, and hemorrhage, which are included as black-box warnings."
Report promptly — see the oncologic-emergencies page.
Caution: [OVAR] Chemotherapy adverse effects
General chemotherapy adverse effects include "catheter complications, nausea, vomiting, dehydration, and abdominal pain."

Medications for this condition

Why each class is prescribed here — every card links to its full pharmacology page.

Vaccines & Immunizations First-line
Immune / Anti-infective

[HPVV] HPV vaccine (CDC/ACIP). "HPV vaccine is recommended for routine vaccination at 11 or 12 years old. Vaccination can be started at age 9." Catch-up "for everyone through age 26 years if not adequately vaccinated"; ages 27–45 by shared decision with a clinician. Two doses if the series starts before the 15th birthday, the second "6 to 12 months after the first dose" (two doses less than 5 months apart need a third). Three doses (0, 1–2 and 6 months) if started at 15–26, and for immunocompromised persons aged 9–26 including HIV. It "prevents new HPV infections but does not treat existing HPV infections or diseases." Adolescents should be seated or lying down during vaccination and for 15 minutes afterward (syncope). Contraindicated after a severe allergic reaction to a prior dose or component, and with immediate hypersensitivity to yeast; not recommended during pregnancy, but "pregnancy testing before vaccination is not needed."
Antineoplastic / Chemotherapy Overview High-alert
Oncology

[CERV] "Concurrent cisplatin-based chemotherapy with radiation therapy is the standard of care for women who require radiation therapy for treatment of cervical cancer"; carboplatin if cisplatin is not tolerated (e.g., renal disease). Platinum toxicities: myelosuppression incl. febrile neutropenia, nephrotoxicity, neurotoxicity. [OVAR] Platinum-based chemotherapy with debulking surgery; intraperitoneal delivery "directly into the peritoneal cavity"; PARP inhibitors olaparib, rucaparib and niraparib as maintenance for certain recurrent disease; bevacizumab (most severe effects: gastrointestinal perforation, impaired wound healing and hemorrhage). No doses here — see the class page.
Antiemetics
Digestive / GI · ondansetron

Nausea and vomiting are listed chemotherapy and end-of-life effects in ovarian cancer (StatPearls); the sources name no specific antiemetic — role only.

Beyond medications

  • [CERV] Precancer treatment — "Cryotherapy or excision is performed to manage precancerous lesions limited in size and depth. Conization, laser, or loop electrosurgical excision procedure (LEEP) are used to manage lesions that include the endocervical canal and are more extensive."
  • [CERV] Radical hysterectomy — open abdominal surgery is the NCI-described standard for early-stage candidates.
  • [CRT] External-beam radiation plus brachytherapy with concurrent cisplatin when radiation is needed; complete it without delay.
  • [BT] Brachytherapy applicator placement — dorsal lithotomy position, a Foley catheter with contrast in the balloon, vaginal packing to displace bladder and rectum, and anesthesia "to help optimize patient comfort and procedure mechanics."
  • [OVAR] Debulking surgery by an experienced gynecologic oncologist — hysterectomy, bilateral salpingo-oophorectomy, omentectomy; fertility-sparing unilateral salpingo-oophorectomy "may be done in certain women who wish to have children."
  • [OVAR] Risk-reducing oophorectomy for high-risk women — "In high-risk women, this procedure has been shown to greatly decrease the risk of ovarian cancer."

Nursing considerations

The RN-specific layer — each action paired with the reason it matters.

Assessment
Check HPV vaccine status and cervical screening history against age-based intervals.
Why: Most cervical cancer deaths occur in women not adequately screened; vaccination prevents new infection.
Ask about abnormal vaginal bleeding (after sex, between periods, after menopause), discharge and pain during intercourse.
Why: Classic cervical-cancer symptoms; CDC advises seeing a doctor "right away" for unusual bleeding.
Take persistent bloating, early fullness, pelvic pain and urinary urgency seriously — ask how long (2 weeks or more?) and whether new.
Why: Ovarian cancer symptoms are vague and "often advanced" when they appear; CDC uses a 2-week threshold.
Take a family history of ovarian and breast cancer.
Why: Women with such a history "may be at risk for a hereditary cancer syndrome" and need a counseling referral.
During chemoradiation, monitor CBC, renal function, neuropathy, urine (hematuria, dysuria) and bowel pattern (tenesmus, rectal bleeding).
Why: Platinum toxicities plus radiation cystitis and proctitis.
Interventions
LDR implant in place: private room; staff may stand at a distance, talk from the doorway and wear protective clothing; post visitor rules — about 30 minutes or less a day, no pregnant visitors or children younger than 1 year, no visits when the source is first placed.
Why: The patient "will give off radiation for a while"; NCI lists these room and visitor measures.
Give pain medicine before the applicator is removed; after removal, reassure the patient and family that no radiation remains.
Why: "There is no radiation in your body after the catheter or applicator is removed. It is safe for people to be near you–even young children and pregnant women."
Heavy hematuria with clots after pelvic radiation: escalate immediately and prepare for cystoscopy with clot evacuation and irrigation; review antiplatelet and anticoagulant drugs with the provider.
Why: Radiation cystitis "can range from mild to severe and life-threatening."
Seat or lie adolescents down for 15 minutes after HPV vaccination.
Why: CDC syncope precaution.
Refer women with a strong family history for genetic counseling.
Why: USPSTF: they "should discuss their family history with their health care professional"; about 20% of ovarian cancer is hereditary.
Patient and family teaching
The HPV vaccine prevents infection but does not treat it — and vaccinated women still need screening.
Why: "women who have been vaccinated should continue to be screened as recommended."
There is no screening test for ovarian cancer in average-risk women; know what is normal for your body and see a provider for symptoms lasting 2 weeks or more, or unusual vaginal bleeding right away.
Why: USPSTF Grade D against screening; CDC: "Pay attention to your body, and know what is normal for you."
After pelvic radiation, use a vaginal dilator as instructed and report rectal bleeding, blood in the urine or painful urination.
Why: Vaginal stenosis develops over months to years; proctitis and cystitis are late effects.
After brachytherapy, limit strenuous activity for a week or two; the applicator area may stay tender for months.
Why: NCI post-removal guidance.
Discuss fertility plans before treatment — radiation-induced ovarian failure typically occurs within 6 to 12 months; some fertility-sparing options exist.
Why: StatPearls and NCI; fertility-sparing surgery is possible for selected women.

How a real nurse thinks

The clinical-judgment loop, worked for a typical presentation — reasoning, not reference.

  1. 1
    Recognize cues

    An LDR implant is in place, and a pregnant visitor with an infant plans a long bedside visit. The patient also has teaching questions about her daughter's vaccine and about radiation after discharge.

  2. 2
    Analyze cues

    While the source is in, the patient "will give off radiation for a while." NCI restricts visits to about 30 minutes or less a day at the doorway and does not allow pregnant women or children younger than 1 year. The teaching questions are important but not urgent.

  3. 3
    Prioritize

    Protect the pregnant visitor and infant from radiation exposure first, kindly and privately; teaching comes next.

  4. 4
    Generate solutions

    Explain the rule to the sister, offer a phone or video call instead, and plan a visit after the applicator is removed. Then answer the questions: 2 HPV doses for a 13-year-old, 6–12 months apart; no radiation remains after removal.

  5. 5
    Take action

    The sister and baby wait outside and call from the lobby. The nurse confirms visitor signage, then teaches the vaccine schedule and removal plan, including pain medicine before the applicator comes out.

  6. 6
    Evaluate

    The patient correctly states that her daughter needs 2 doses and that her family can be near her once the applicator is removed; no further visitor breaches occur.

Scenario — you’re the nurse

Work each question before revealing the answer. Rationales explain the wrong options too.

Gynecologic oncology unit · LDR brachytherapy day 2, 1300

A 44-year-old woman with locally advanced cervical cancer finished external-beam radiation with concurrent cisplatin and now has a low-dose-rate brachytherapy implant in place in a private room. She was never screened after age 30. Her 13-year-old daughter has not had the HPV vaccine.

1300 — her pregnant sister arrives with an 8-month-old baby and plans to sit at the bedside for the afternoon
Vital signs — BP 118/72 · HR 84 · T 37.0 °C · pain 3/10
Labs this morning — creatinine stable; platelets and neutrophils low but improving
Patient asks — ‘Does my daughter need the HPV shot, and how many?’ and ‘Will I be radioactive when I go home?’
Q1 Multiple choice
A patient has a low-dose-rate cervical brachytherapy implant in place. Which visitor can the nurse allow, following NCI precautions?
  1. A. A pregnant sister who wants to stay all afternoon
  2. B. An 8-month-old grandchild held by her husband
  3. C. Her adult husband for a short visit, standing by the doorway
  4. D. Any visitor at all on the day the source is first put in
Reveal answer & rationale
Answer: C
NCI allows visitors to stand "by the doorway rather than going into your hospital room" and keep visits "about 30 minutes or less each day" (C). Pregnant women (A) and "children younger than a year old" (B) should not visit, and visitors are not allowed "when the radiation is first put in" (D).
Q2 Multiple choice
The patient asks how many HPV vaccine doses her 13-year-old daughter needs. What is the correct answer?
  1. A. One dose is enough at any age
  2. B. Two doses, the second 6 to 12 months after the first
  3. C. Three doses at 0, 1–2 and 6 months
  4. D. None — she should wait until she is sexually active
Reveal answer & rationale
Answer: B
CDC: "Two doses of HPV vaccine are recommended for most people starting the series before their 15th birthday," with the second dose "6 to 12 months after the first dose" (B). The sources give no one-dose schedule (A). Three doses (C) are for starts at 15–26 or immunocompromised persons. The vaccine "works best when given before any exposure to HPV," routinely at 11–12 (D).
Q3 Select all that apply
Which statements about USPSTF (2018) cervical cancer screening are correct? Select all that apply.
  1. A. Ages 21–29: cytology alone every 3 years
  2. B. Ages 30–65: cytology every 3 years, HPV testing alone every 5 years, or cotesting every 5 years
  3. C. Begin Pap tests at first sexual activity, even before 21
  4. D. Stop after 65 if prior screening was adequate and risk is not high
  5. E. Women vaccinated against HPV no longer need screening
  6. F. A woman living with HIV is outside the routine recommendation and needs individualized follow-up
Reveal answer & rationale
Answer: A, B, D, F
A, B and D restate the 2018 USPSTF recommendation; F is correct because the statement "does not apply to … women who have a compromised immune system (eg, women living with HIV)." Screening before 21 is recommended against (C). Vaccinated women "should continue to be screened as recommended" (E).
Q4 Multiple choice
A 52-year-old woman with no family history asks for a yearly CA-125 test to screen for ovarian cancer. Which response is best?
  1. A. CA-125 every year is the standard screening test after 50
  2. B. Screening average-risk women with CA-125 or ultrasound does not reduce deaths and causes false positives; report symptoms such as bloating or pelvic pain lasting 2 weeks or more
  3. C. A normal CA-125 rules out ovarian cancer
  4. D. A yearly pelvic exam will find ovarian cancer early instead
Reveal answer & rationale
Answer: B
USPSTF found that CA-125, transvaginal ultrasound or both "does not reduce ovarian cancer mortality" and causes "many false-positive results" (Grade D); CDC advises seeing a doctor for symptoms lasting 2 weeks or more (B). There is no recommended CA-125 screening (A). CA-125 is raised in only about half of early cases (C). The USPSTF recommends against screening asymptomatic average-risk women for ovarian cancer, so a yearly pelvic exam is not a substitute screen (D).
Q5 Multiple choice
Six months after chemoradiation for cervical cancer, a patient reports passing blood clots in her urine. How should the nurse triage this?
  1. A. Expected after radiation — recheck at the next routine visit
  2. B. Escalate now — radiation cystitis can be severe and life-threatening, and severe cases need cystoscopy with clot evacuation
  3. C. Encourage cranberry juice and wait 1 week
  4. D. Tell her to stop her vaginal dilator
Reveal answer & rationale
Answer: B
Chronic radiation cystitis can range "from mild to severe and life-threatening," and "A cystoscopy with clot evacuation and irrigation is necessary in more severe cases" (B). Clots are not routine (A); waiting (C) delays care; the dilator (D) prevents vaginal stenosis and is unrelated.

Common questions

What causes cervical & ovarian cancer?
Common causes and risk factors include [cerv] persistent high-risk hpv infection — "the primary risk factor for cervical cancer is human papillomavirus (hpv) infection.", [cerv] smoking (with hpv infection), [cerv] immunosuppression — e.g., hiv; these women are outside the routine uspstf screening recommendation and need individualized follow-up, [cerv] long-term oral contraceptive use (with hpv infection) and high parity (with hpv infection), [cerv] first sexual encounter at a young age; many sexual partners, and others.
How are cervical and ovarian cancer different for screening?
Cervical cancer has an effective screen (USPSTF 2018: cytology every 3 years from 21–29; cytology, HPV testing or cotesting from 30–65) because its HPV-driven precancer grows slowly. Ovarian cancer has none for average-risk women — USPSTF recommends against CA-125 or ultrasound screening (Grade D).
Is the 2024 USPSTF cervical screening statement in effect?
It is a draft (December 10, 2024) that would prefer HPV primary screening every 5 years from 30, including patient-collected samples. "When finalized, this recommendation will update the 2018 USPSTF recommendation" — until then the 2018 statement is current.
Why two HPV doses for some and three for others?
CDC: two doses if the series starts before the 15th birthday (6–12 months apart); three doses (0, 1–2, 6 months) if it starts at 15–26 or the person is immunocompromised, including HIV.
Is a patient with brachytherapy radioactive after going home?
Not after a removable implant: "There is no radiation in your body after the catheter or applicator is removed." Permanent implants are different — NCI advises being "extra careful not to spend time with children or pregnant women."
Do birth control pills raise or lower these cancers?
Opposite directions. Oral contraceptives reduce ovulation and lower ovarian cancer risk; long-term use with HPV infection is listed by NCI as a cervical cancer risk factor.

Sources

Reviewed by Hae Suk Lee, RN

Educational summary for nursing students. Scenarios are fictional teaching cases. Always verify against current guidelines and your institution's protocols before acting in practice. Not medical advice.

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