Interventions for Cervix uteri cancer

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Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding exposure to tobacco smoke Reproductive health education on the benefit of reduced sexual partners and use of condoms Pursue intersectoral collaborations, with Ministry of Agriculture and its	Guidance on primary prevention measures incluing : Absitence from sex for the aldolesents or safe sex practices (use of condom) avoidance of smoking (benzyenes are known to damage the cervix) Guidance on self observance and taking note of any unusual symptoms eg bleeding between periods, abnormal discharge Human Papilloma Virus (HPV) Vaccination through outrteaches to community level			Social Marketing campaigns instituted towards generating empathy and promotion social inclusion of those who have completed a treatment cycle	Set up publicly owned-and-run hospices Promote private sector participation in setting up hospices and palliative care centres
Primary Care
create awareness on cervix-uteri cancer; risk factors and prevention measures Health and Wellness education on;- diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding smoking or exposure to tobacco smoke Reproductive health education on the benefit safe sex practices including use of condoms	Guidance on primary prevention measures incluing : Absitence from sex for the aldolesents or safe sex practices (use of condom) avoidance of smoking (benzyenes are known to damage the cervix) Guidance on self observance and taking note of any unusual symptoms eg bleeding between periods; abnormal discharge HPV vaccine		Physical and clinical examination prompt referral to hospital for management Follow up on adherence to treatmemt Screening for cervical cancer	Provision of Clinical Psychology services as part of Primary Care for clients who have completed treatment cycles	Psycho social support for patient and their family members or care givers Counseling for the patient and familiy members Spiritual support
Referral Facility: General
Create awareness on cervix-uteri cancer, risk factors and prevention measures Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding smoking or exposure to tobacco smoke Reproductive health education on the benefit safe sex practices including use of condoms	Guidance on primary prevention measures incluing : Absitence from sex for the aldolesents or safe sex practices (use of condom) avoidance of smoking (benzyenes are known to damage the cervix) Guidance on self observance and taking note of any unusual symptoms eg bleeding between periods, abnormal discharge HPV vaccination		Stages IA1 and IA2 – Surgery (Modified Radical Hysterectomy, Lymphadenectomy) and Brachytherapy Stages IB1, IB2, IIA1 – Open Radical Hysterectomy or Brachytherapy, External Pelvic Radiotherapy and Chemotherapy where surgery may not be indicated Stages IB3, IIA2, IIB, III, IVA – External Pelvic Radiation, Brachytherapy and Chemotherapy. Stage IVB and Recurrent Cancers – Chemotherapy		Palliatve pain relief Set up publicly run hospices Psycho social support for patient and their family members or care givers Counseling for the patient and familiy members Spiritual support
Referral Facility: Specialist
Create awareness on cervix-uteri cancer, risk factors and prevention measures Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding smoking or exposure to tobacco smoke Reproductive health education on the benefit safe sex practices including use of condoms	Guidance on primary prevention measures incluing : Absitence from sex for the aldolesents or safe sex practices (use of condom) avoidance of smoking (benzyenes are known to damage the cervix) Guidance on self observance and taking note of any unusual symptoms eg bleeding between periods; abnormal discharge HPV vaccination		Physical and clinical examination supportive managemnet including: pain relieve Nutritionla support Admission where necessary managemnet of opportunitsic infections Management of any underlying conditions INVESTIGATIONS /diagnostics screening -PAP smear colscopic examination Blood tests Biopsy Other tests eg to check for metastasis x-rays CT scan PET scan Monitoring and managemnet of any complications Blood transfusions Oxygen therapy Chemotherapy Surgical interventions eg hysterectomy; Brachytherapy Radiotherapy INtensive care unit services Follow up invclidng counselling for compliance with treatmnent		Palliatve pain relief Set up publicly run hospices Psycho social support for patient and their family members or care givers Counseling for the patient and familiy members Spiritual support

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community engagement and empowerment on cancer awareness and early health-seeking behaviour Community leaders and advocates engagement to address cancer stigma and identification of barriers to accessing care	Safe sexual practice Correct and consistent use of condoms HPV vaccination at earlier age	Recognition of cancer signs and symptoms	Early recognition of need for referral	Physical exercise Nutritional support	Home-based care with multi-disciplinary team with access to opiates and essential supportive medicines Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Primary Care
Health education on prevention and management of cervical cancer	Safe sexual practice Correct and consistent use of condoms HPV vaccination at earlier age Screening and treatment of precancerous lesions	Recognition of cancer signs and symptoms Visual inspection with acetic acid (VIA) HPV assay	Cryotherapy Early referral of suspicious cases	Physical exercise Nutritional support	Multi-disciplinary team with access to opiates and essential supportive medicines Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Referral Facility: General
Health education on prevention and management of cervical cancer	Screening and treatment of precancerous lesions	History Physical examination Pelvic examination Pap smear Colposcopy with Cone biopsy Punch biopsy HPV Assay Endo-cervical curettage X-ray Ultrasound	History and physical examination for cervical cancer Cervical cancer screening using HPV-test or Visual inspection with acetic acid (VIA) Treatment of precancerous lesions with Cryotherapy and/or LEEP Early recognition of need for referral	Physical exercise Nutritional support	Multi-disciplinary team with access to opiates and essential supportive medicines Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care
Referral Facility: Specialist
Health education on prevention and management of cervical cancer	Screening and treatment of precancerous lesions	History Physical examination Pelvic examination Pap smear Colposcopy with Cone biopsy Punch biopsy HPV DNA test Endo-cervical curettage X-ray Ultrasound Computed tomography	Chemotherapy Simple hysterectomy Radical hysterectomy Targeted drug therapy Immunotherapy Radiotherapy	Physical exercise Nutritional support	Hospital-based care with multidisciplinary team with access to opiates and essential supportive medicines Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community engagement and empowerment on cancer awareness and early health-seeking behaviour Community leaders and advocates engagement to address cancer stigma and identification of barriers to accessing care	Safe sexual practice Correct and consistent use of condoms HPV vaccination at earlier age	Recognition of cancer signs and symptoms	Early recognition of need for referral	Physical exercise Nutritional support	Opioid analgesia for effective control of moderate-to-severe pain Symptomatic non-pharmacological treatment Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care*
Primary Care
Health education on prevention and management of cervical cancer	Safe sexual practice Correct and consistent use of condoms HPV vaccination at earlier age Screening and treatment of precancerous lesions	Recognition of cancer signs and symptoms Visual inspection with acetic acid (VIA) HPV assay	Cryotherapy Early referral of suspicious cases	Physical exercise Nutritional support	Opioid analgesia for effective control of moderate-to-severe pain Symptomatic non-pharmacological treatment Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care*
Referral Facility: General
Health education on prevention and management of cervical cancer	Screening and treatment of precancerous lesions	History Physical examination Pelvic examination Pap smear Colposcopy with Cone biopsy Punch biopsy HPV Assay Endo-cervical curettage X-ray Ultrasound	Cryotherapy Loop electrosurgical excision procedure (LEEP) Intra-cavitary brachytherapy	Physical exercise Nutritional support	Opioid analgesia for effective control of moderate-to-severe pain Symptomatic non-pharmacological treatment Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care*
Referral Facility: Specialist
Health education on prevention and management of cervical cancer	Screening and treatment of precancerous lesions	History Physical examination Pelvic examination Pap smear Colposcopy with Cone biopsy Punch biopsy HPV DNA test Endo-cervical curettage X-ray Ultrasound Computed tomography	Chemotherapy Simple hysterectomy Radical hysterectomy Targeted drug therapy Immunotherapy Radiotherapy	Physical exercise Nutritional support	Opioid analgesia for effective control of moderate-to-severe pain Symptomatic non-pharmacological treatment Emotional, social, spiritual assessment and support based on cultural needs, values and preferences of patients and families Linkage to address financial well-being of patients and family members End-of-life care

Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Health and Wellness education on;- diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding smoking or exposure to tobacco smoke Reproductive health education on the benefit safe sex practices including use of condoms	Guidance on primary prevention measures incluing : safe sex practices (use of condom) avoidance of smoking (benzyenes are known to damage the cervix) Guidance on self observance and taking note of any unusual symptoms eg bleeding between periods; abnormal discharge screening for cervical cancer at community level through outreaches				Psycho social support for patient and their family members or care givers Counseling for the patient and familiy members Spiritual support
Primary Care
Create awareness on cervix-uteri cancer; including on risk factors and prevention measures Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding smoking or exposure to tobacco smoke Reproductive health education on the benefit safe sex practices including use of condoms	Guidance on primary prevention measures incluing : safe sex practices (use of condom) avoidance of smoking (benzyenes are known to damage the cervix) Guidance on self observance and taking note of any unusual symptoms eg bleeding between periods; abnormal discharge HPV vaccination Routine cervical cancer screening		physical and clinical assessmment prompt referral to a hospital for further managmnet Follow up on adherence to treatmnet Screening for cervical cancer		Psycho social support for patient and their family members or care givers Counseling for the patient and familiy members Spiritual support
Referral Facility: General
Create awreness on cervix-uteri cancer; risk factors and preventon measure Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding smoking or exposure to tobacco smoke Reproductive health education on the benefit safe sex practices including use of condoms	Guidance on primary prevention measures incluing : safe sex practices (use of condom) avoidance of smoking (benzyenes are known to damage the cervix) Guidance on self observance and taking note of any unusual symptoms eg bleeding between periods; abnormal discharge HPV vaccine Routine cervical cancer screening		Physical and clinical examination supportive managemnet including: pain relieve Nutritionla support Admission where necessary managemnet of opportunitsic infections Management of any underlying conditions Monitoring and managemnet of any complications Blood transfusions Oxygen therapy Surgical interventions eg hysterectomy;further managemnet including managemnet of any complications referral to specialised hospital for Follow up invclidng counselling for compliance with treatmnent INVESTIGATIONS /diagnostics screening -PAP smear colscopic examination Blood tests Other tests eg to check for metastasis x-rays eg chest r-ray CT scan		palliative pain relief Set up publicly run hospices Psycho social support for patient and their family members or care givers Counseling for the patient and familiy members Spiritual support
Referral Facility: Specialist
Create awreness on cervix-uteri cancer; risk factors and preventon measure Health and Wellness education on diet management, regular exercise, weight management, reduced exposure to radiation, reducing alcohol intake and avoiding smoking or exposure to tobacco smoke Reproductive health education on the benefit safe sex practices including use of condoms	Guidance on primary prevention measures incluing : safe sex practices (use of condom) avoidance of smoking (benzyenes are known to damage the cervix) Guidance on self observance and taking note of any unusual symptoms eg bleeding between periods; abnormal discharge HPV vaccine Routine cervical cancer screening		Physical and clinical examination supportive managemnet including: pain relieve Nutritionla support Admission where necessary managemnet of opportunitsic infections Management of any underlying conditions INVESTIGATIONS /diagnostics screening -PAP smear colscopic examination Blood tests Biopsy Other tests eg to check for metastasis x-rays CT scan PET scan Monitoring and managemnet of any complications Blood transfusions Oxygen therapy Chemotherapy Surgical interventions eg hysterectomy; Brachytherapy Radiotherapy INtensive care unit services Follow up invclidng counselling for compliance with treatmnent		palliative pain relief Set up publicly run hospices Psycho social support for patient and their family members or care givers Counseling for the patient and familiy members Spiritual support