Posted on 23rd Sep 2024 07:09:44 PM Medicine
1.1 Introduction
Cancer is one of the major causes of morbidity and mortality among the non communicable Bangladesh. Each year more than 200,000 people develop cancer and 150,000 die of the disease. Cancer is the sixth cause of mortality in Bangladesh and more than half of the cancer patients die within five years of diagnosis. The number of people developing cancer is expected to increase in huge number mainly because of ageing population and lifestyle factors. Cancer load is more than 1,200,000 in Bangladesh. At present we have enough knowledge to prevent at least one-third of cancers. Depending on that availability of resources, early detection and effective treatment of a further third of cancers are also possible. And when cancer cannot be cured, or held in remission, prevention and relief of suffering can greatly improve the quality of life of people with cancer and their families.
The whole field of cancer is complex, and achieving what is possible poses significant challenges. Cancer includes over a hundred diseases with different causes. It can arise in any organ and at any age. Also, there is a wide range of organizations and health professionals, both government and non-government, involved in the many aspects of cancer prevention, detection, diagnosis, treatment and care (WHO, 1995).
Bangladesh is still lacking a national cancer registry. According to Bangladesh Bureau of Statistics cancer is the sixth leading cause of death in Bangladesh (BBS, 2008). A few decades ago, a hospital based registry was initiated in 1967 at Radiotherapy Department of Dhaka Medical College Hospital and continued till 1971. A few years back, hospital based cancer registry was instituted at National Institute of Cancer Research Hospital and Oncology Department of Bangabandhu Sheikh Muijb Medical University. International Agency for Research on Cancer (IARC) has been estimated death from cancer in Bangladesh is 7.5 % in 2005 and projected that it would be increased upto 13 % in 2030. IARC has been projected death from 10 leading cancers in women are mouth and oro-phyrangeal cancer, cervical, breast, oesophageal cancer, ovarian cancer, lung cancer, lymphoma, stomach, liver, colorectal cancer and in men are mouth and orophyrangeal, lung cancer, oesophageal cancer, lymphoma, stomach, bladder, liver cancer, leukaemia, colorectal cancer and prostate. A recent WHO study has been estimated that there are 49,000 oral cancer, 71,000 pharynx & laryngeal cancer and 196,000 lung cancer cases in Bangladesh among those aged 30 years or above. The same study observed that 3.6% of the admissions in medical college hospitals for the same age group are due to cancers of oral cavity larynx (BBS, 2008).
Cancer is a major challenge for our society today. Cancer affect large number of people worldwide and it has devastating effect on individual, family and society. However there is much reason for optimism. Major achievements has been obtained for prevention and cure and in coming years huge improvement in treatment of all types of cancer is expected, but these well come improvements will place substantial and diverse pressure on our health care system. The ageing of our population will result in an increasing number of people who will develop cancer in Bangladesh in the coming days. It is self-evident that the current services will not be in a position to meet the substantial demand for treatment, cure and care. Keeping pace with these demands will require a major government commitment to concern prevention and curative services in the coming years, which in turn will require the earliest possible decisions on investment, human resource planning and the organization of services. Our aim is to control major risk factors, and deliver a universal, quality-based and timely service, in line with the best practices that are currently available in the world (Cancer Council Australia, 2001)
Cervical cancer is a global disease, despite presenting the greatest potential for prevention and cure (nearly 100%) when diagnosed early. It is the most common cancer in women of the developing countries where screening facilities are inadequate. Cervical cancer is a preventable disease as the different screening, diagnostic and therapeutic procedures are effective. At present throughout the globe, there are nearly 1 million women each year having cervical cancer.
In most of the developing countries carcinoma of the breast and cervix are the leading site of malignancies in female and are major public health problems.
In India, twelve population based cancer registries (PBCRs) showed cancer breast was the most common followed by cancer of the cervix (ICMR-2004). In female cancers, relative proportion of cancer breast varied between 21and 24 percent whereas that of cancer cervix was between 14 and 24 percent.
Major factors affecting the prevalence of carcinoma cervix in a population are economic factor, sexual behaviour and degree of effective mass screening.
Age: Any woman who has ever had sex is at risk of developing cancer of the cervix, but the risk increases as a woman gets older. Currently, age is the most reliable predictor of risk for cancer of the cervix. The risk is greater in women over 35 y ears.
HPV infection: not all women who are infected with HPV develop cancer of the cervix and it is not currently possible to predict which women with HPV infection will actually develop cancer of the cervix. In fact, only about 5% of women infected with HPV go on to develop cancer of the cervix later in life1. However, in recent years, research has shown that particular types of HPV (high risk types), in association with other cofactors, such as smoking and immune suppression, are largely responsible for most cases of cancer of the cervix. Thus, women who are infected with these high risk types of HPV are considered to be at higher risk of developing cancer of the cervix than women infected with the other low risk types of HPV who are over the age of 35 years are at greater risk of developing the precursor lesions of cancer of the cervix. A lot is not yet known about the exact nature of the role of HPV in the development of cancer of the cervix, but some facts are certain: (U.S. Department of Health and Human Services, 2000).
Persistent infection with HPV plays a central role in the development of cervical dysplasia11, 12
High risk HPV infection is a good predictor of subsequent high grade dysplasia in young women, and an even better older women.
Smoking1: tobacco use may influence whether a woman with dysplasia is likely to develop cancer of the cervix.
Immune suppression1: exact role is not known, but immune suppression, especially related to HIV infection, also plays a mediation role.
Hormonal factors1: use of contraceptives, early age at first birth and high parity also play a role in mediating the disease.
Sexual behaviour1: younger age at first intercourse and having multiple sex partners have frequently been cited at risk factors for cancer of the cervix, but these are now thought to be indicators of exposure to HPV infection and are not independent
Women who do not have Pap tests
Women who do not follow up with testing or treatment after an abnormal Pap test, as told by their health care provider
Women who have persistent HPV
Women who smoke
If a smear is abnormal, you may be asked to have a repeat smear, or (particularly if there has been more than one abnormal smear) be sent to a specialist for further checks. The most common symptom is bleeding between periods or after sex. Menstrual abnormalities in the form of contact bleeding or bleeding on straining (duration defecation), intermenstrual bleeding are very much suspicious, specially over the age of 35. Excessive white discharge which may be at times offensive. Other symptoms includes-
Any sort of unusual or unpleasant smelling vaginal discharge, Discomfort/pain during intercourse, Pain in the pelvic area, Painful or difficult urination (Programme for Appropriate Technology in Health 2000).
Cervical cancer staging areas following-
Stage I - cervical cancer confined to the cervix (extension to corpus should be disregarded)
Stage IA - invasive carcinoma diagnosed only by microscopy. All macroscopically visible lesions, even with superficial invasion, are stage IB/T1b (cancer is < 3 mm in depth with < 7 mm horizontal spread).
Stage IA1 - confined to the cervix, diagnosed only by microscopy with invasion of < 3 mm in depth with lateral spread < 7 mm.
Stage IA2 - confined to the cervix, diagnosed with microscopy with invasion of > 3 mm in depth and lateral spread < 7 mm.
Stage IB - clinically visible lesion confined to the cervix or microscopic lesion > IA2/T1a2.
Stage IB1 – clinically visible lesions or greater than A2, < 4 centimeters (cm) in greatest diameter.
Stage IB2 – clinical visible lesion > 4 cm in size.
Stage II - tumour invades beyond uterus but not to pelvic wall or to lower third of vagina.
Stage IIA – tumour without parametrical involvement.
Stage IIA1 – involvement of the upper two-thirds of the vagina, without parametrical invasion, < 4.0 cm in greatest dimension.
Stage IIA2 - clinically visible lesion > 4.0 cm in greatest dimension.
Stage IIB – tumour with parameterial involvement.
Stage III - tumour extended to pelvic wall and/or involves lower third of the vagina and/or causes hydronephrosis or nonfunctioning kidney.
Stage IIIA - tumour involves lower third of vagina, no extension to pelvic wall.
Stage IIIB - tumour extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney.
Stage IVA - tumour invades mucosa of bladder or rectum, and/or extends beyond true pelvis (bulbous edema is not sufficient to classify a tumor as T4).
Stage IVB – distant metastasis (American Joint Committee on Cancer 2010)
The following complications may occur sooner or later, as the lesion progresses.
Haemorrhage.
Frequent attacks of ureteric pain, due to pyelitis and pyelonephritis and hydronephrosis.
Pyometra-specially with endocervical variety.
Vesicovaginal fistula.
Rectovaginal fistula.
1.2 Justification of the study
Cancer is a major challenge for our society today .Cancer affect large number of people worldwide and it has devastating effect on individual, family and society. Cervical cancer is a global disease, despite presenting the greatest potential for prevention and cure (nearly 100%) when diagnosed early. It is the most common cancer in women of the developing countries where screening facilities are inadequate. Cervical cancer is a preventable disease as the different screening, diagnostic and therapeutic procedures are effective. At present throughout the globe, there are nearly 1 million women each year having cervical cancer.
From this study it would be possible to assess the knowledge of stuff nurses on risk factors and care of cervical cancer. The lack of system or insufficiency in care is possible to detect. Patients have the right to get best qualities nursing care. Patient satisfaction is the main aim of any nursing care. The aim of the study to assess the quality of nursing care given by the stuff nurse in cervical cancer as indicated by patients’ benefits.
This study will be described nurses knowledge about risk factors and care of cervical cancer. The World Health Organization (WHO) advises that the epidemiology of the disease should be known and be of sufficient importance to justify its prioritization, and that surveillance systems should be capable of assessing the impact of a vaccine intervention following its introduction.
1.3 Objectives
General objectives
The study will be carried out a view to assess nurses knowledge regarding the risk factors and care of cervical cancer patient.
Specific objectives
- To assess knowledge on cervical cancer.
- To assess knowledge on risk factors of cervical cancer.
- To assess knowledge on responsible organism of cervical cancer.
- To assess knowledge on complication of cervical cancer.
- To assess knowledge on vaccine of cervical cancer.
- To assess knowledge on care of cervical cancer patient.
- To find out the socio demographic characteristic of the respondent.
1.4 Research question
What is the knowledge of nurses on the risk factors and care of cervical cancer.
1.5 Variables use in this study
Dependent variables: Nurses knowledge regarding the risk factors and care of cervical cancer.
Independent variables:
- Age
- Sex
- Marital status
- Religion
- Professional qualification
- Length of service
- Monthly income
- Specialization on course
CONTENTS
Abstract
CHAPTER-1: INTRODUCTION
1.1 Introduction
1.2 Justification of the study
1.3 Objectives of the study
1.4 Research question
1.5 Variables use in this study
CHAPTER-2: REVIEW OF LITERATURE
02 Review of literature
CHAPTER-3: MATERIALS AND METHODS
3.1 Study design
3.2 Study place
3.3 Study duration
3.4 Study population
3.5 Sample size
3.6 Sampling technique
3.7 Data collection instrument
3.8 Data collection procedure
3.9 Data analysis
3.10 Ethical clearance
CHAPTER-4: RESULTS
4.1 Demographic information of nurses
4.2 Nurses knowledge regarding the risk factors and care of cervical cancers
CHAPTER-5: DISCUSSION
05 Discussion
CHAPTER-6: CONCLUSION And RECOMMENDATION
6.1 Conclusion
6.2 Recommendation
CHAPTER-7: REFERENCES
07 References
CHAPTER-8: ANNEXURE
8.1 Consent letter
8.2 Questionnaire
LIST OF FIGURES
1.1 Distribution of the respondent by their sex
1.2 Distribution of the respondent by their professional qualification
1.3 Distribution of the respondent by their specialization on course
2.1 Nurses knowledge on cervical cancer
2.2 Nurses knowledge on who is at risk for cervical cancer
2.3 Nurses knowledge on types of treatment for cervical cancer
LIST OF TABLES
1. Distribution of the respondent by their socio demographic characteristic
2. Distribution of the respondent by their knowledge regarding the risk factors and care of cervical cancer
Thesis, Assessment, Nurses, Knowledge, Regarding, Risk, Factors, Care, Cervical, Cancer, Rajshahi, Nursing, College, Medical, Hospital
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