An observational study of screening, diagnosis, and management of operable cases of cervical cancer in a tertiary institute

Background: One in every five women suffering from cervical cancer belongs to India. Objectives: In this study, an attempt has been made to screen for cervical cancer in all sexually active females attending Gynaecology Out Patient Department (OPD), segregate operable and inoperable cases, study varying operative management of diagnosed cases of cervical cancer, and study the outcome and complications of the same. Materials and Methods: This was a prospective study carried out in the Department of Obstetrics and Gynaecology in a tertiary care referral hospital in Mumbai amidst the largest urban slum in Asia, Dharavi from January 2011 to December 2016. A total number of 36,100 patients attended the Gynecology OPD during the study period. Being an observational study, only percentage calculations were used in this study. Results: Incidence of neoplasia in this cohort by Pap smear cytology was 0.48%, thus proving the sensitivity of Pap smear to be 84.57%. Most of patients with cervical cancer belonged to the age group 30-39 years (35.9%), lower socioeconomic class (78.18%), and were multiparous (66.36%). Most common presenting complaint was abnormal vaginal discharge (including bleeding) occurring in 87%. Most common histopathological type was squamous cell carcinoma (81.81%). Total abdominal hysterectomy was done in 12 patients (Stage 1a1), Type 2 hysterectomy with pelvic lymph node dissection was done in 16 patients (Stage 1a2, Stage 1b1), and Type 3 hysterectomy with pelvic lymph node dissection was done in 15 patients (Stage 1b2, Stage 2a). Conclusion: Women continue to be afflicted by a disease that is potentially preventable and treatable when detected early. Those who are lost to screening or who do not receive screening at all are most susceptible to the development of cervical cancer.

Cervical cancer; Pap smear; Radical hysterectomy

[1] GLOBOCON 2012: “Estimated Cancer Incidence Mortality and Prevalence Worldwide in 2012”. International Agency for Research on Cancer, World Health Organisation. Available at: http://globocan.iarc.fr/Default.aspx

[2] Global Health Sector Strategy on Sexually Transmitted Infections 2016 - 2021, World Health Organisation Issue, June 2016. Available at: http://www.afro.who.int/sites/default/files/2017-07/AFR-RC67-7%20Global%20health%20sector%20strategy%20on%20sexu- ally%20transmitted%20-%20Post-PSC_0.pdf

[3] Aswathy S., Quereshi M.A., Kurian B., Leelamoni K.: “Cervical cancer screening: Current knowledge & practice among women in a rural population of Kerala, India”. Indian J. Med. Res., 2012, 136, 205.

[4] Ferlay J., Soerjomataram I., Ervik M., Dikshit R., Eser S., Mathers C., et al.: “GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]”. Available at: http://globocan.iarc.fr

[5] Forouzanfar M.H., Foreman K.J., Delossantos A.M., Lozano R., Lopez A.D., Murray C.J., Naghavi M.: “Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis”. Lancet, 2011, 378, 1461.

[6] Dikshit R., Gupta P.C., Ramasundarahettige C., Gajalakshmi V., Aleksandrowicz L., Badwe R., et al.: “Cancer mortality in India: a nationally representative survey”. Lancet, 2012, 379, 1807.

[7] Shastri S.S., Mittra I., Mishra G.A., Gupta S., Dikshit R., Singh S., Badwe R.A.: “Effect of VIA screening by primary health workers: Randomized controlled study in Mumbai, India”. J Natl Cancer Inst., 2014, 106, dju009.

[8] Ibeanu O.A.: “Molecular pathogenesis of cervical cancer”. Cancer Biol. Ther., 2011, 11, 295.

[9] Sreedevi A., Javed R., Dinesh A.: “Epidemiology of cervical cancer with special focus on India”. Int. J. Womens. Health, 2015, 7, 405.

[10] Arbyn M., Castellsagué X., de Sanjosé S., Bruni L., Saraiya M., Bray F., Ferlay J.: “Worldwide burden of cervical cancer in 2008”. Ann. Oncol., 2011, 22, 2675.

[11] Dhillon P.K, Yeole B.B., Dikshit R., Kurkure A.P., Bray F.: “Trends in breast, ovarian and cervical cancer incidence in Mumbai, India over a 30-year period, 1976-2005: an age-period-cohort analysis”. Br. J. Cancer 2011, 105, 723. Available at: http://dx.doi.org/10.1038/ bjc.2011.301.

[12] Prabhakar A.K.: “Cervical cancer in India—strategy for control”. Indian J. Cancer, 1992, 29, 104.

[13] Saha A., Nag Chaudhury A., Bhowmik P., Chatterjee R.: “Awareness of cervical cancer among female students of premier colleges in Kolkata, India”. Asian Pacific J. Cancer Prev., 2010, 11, 1085.

[14] De Freitas A.C., Gurgel A.P.A.D., Chagas B.S., Coimbra E.C., Do Amaral C.M.M.: “Susceptibility to cervical cancer: An overview”. Gynecol. Oncol., 2012, 126, 304.

[15] Farooqui H.H., Zodpey S.: “Cervical cancer control in India: Taking evidence to action”. J. Public Health Policy, 2012, 33, 165. Available at: http://dx.doi.org/10.1057/jphp.2012.7

[16] Lea J.S., Lin K.Y.: “Cervical cancer”. Obstet. Gynecol. Clin. North Am., 2012, 39, 233.

[17] McKim A., Walter A.C., Sheely K.M., Manahan K.J., Geisler J.P.: “An economic analysis of cisplatin alone versus cisplatin doublets in the treatment of women with advanced or recurrent cervical cancer”. Eur. J. Gynaecol. Oncol., 2016, 37, 353. Available at: http://www.ncbi.nlm.nih.gov/pubmed/27352563

[18] Denny L.: “Prevention of cervical cancer”. Reprod. Health Matters, 2008, 16, 18.

[19] Arbyn M., Sankaranarayanan R., Muwonge R., Keita N., Dolo A., Mbalawa C.G., et al.: “Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India”. Int. J. Cancer 2008;123(1):153-160.