Cervical Cancer in Women with Unhealthy Cervix in a Rural Population of a Developing Country

Abstract

Background: Cervical cancer, the most common malignancy among Indian women, is the second most common and fi fth most fatal cancer in women world-wide. Aim: The study is aimed to determine the risk factors, incidence of cervical malignancy in women with grossly unhealthy cervix in a rural population and to get an overview of eff ectiveness of the existing screening programs. Subjects and Methods: This cross-sectional prospective pilot study was carried in a tertiary care hospital in a span of 6 months. A total of 300 females with grossly unhealthy cervix with suspicions of malignancy, who had never undergone cervical cytology or any other cervical neoplasia screening procedure, were included. Unaided visual inspection with Cusco’s speculum was performed followed by digital examination. Clinical staging was carried out in patients according to International Federation of Gynecology and Obstetrics (FIGO’S) Classifi cation. Cervical punch biopsy was taken under colposcopic guidance and histopathological examinations were done. Data were analyzed using SPSS, version 15.0 (Chicago Illinois, USA) and presented as simple percentages. Results: Among 300 females, 63.4% (190/300) were aged between 40 and 59 years. Nearly, 70.7% were illiterate and 52.6% had monthly family income between Rs. 2,000 and 5,000. Majority was married and 72.7% had parity between 1 and 3 and 58.7% had early marriages. Unaided visual examination of the women showed 62.7% of them had visible growth and 48.7% of them had bleeding erosions. Visible growths along with bleeding erosions were present in 11.3% cases. Histopathological examination of cervical biopsy specimens revealed mild, moderate and severe dysplasia in 14, 22 and 36 cases, respectively. A total of 212 patients had invasive squamous cell carcinoma. Only 16 patients had normal histopathology fi ndings. Nearly, 56.61% had Stage II disease; among them 27 had Stage IIa and 33 had Stage IIb disease, 26 patients had Stage I disease. Stage IIIa and IIIb have been found in 50 and 12 cases respectively. Four cases had cancer extending to urinary bladder and rectum (Stage IVa).  Conclusions: Cervical carcinoma not only has a biomedical spectrum, but also has a wide cultural and socio-economic background. Extensive screening campaigns needs to be implemented with immediate eff ect to early diagnose cases to decrease the social burden of the disease.  Keywords: Africa, cervical cancer, screening procedures