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Cervical Cancer In Northern Nigeria

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Cervical Cancer In Northern Nigeria Powered By Docstoc
					By
Marliyya Zayyan MBBS, FWACS,MRCOG FICS
Senior Lecturer/ Consultant ABUTH Zaria

Risk
 Cancer of the cervix is a sexually transmitted disease.
 All sexually active women are at risk of cervical cancer

 Their risk is however increased if they start sexual intercourse

early.  Have multiple partners or have partners with many partners
 Do not use condoms.
 Acquire HPV infection to the cervix

 Are low in immunity.

Reduced Risk
 The risk of cancer of the cervix is reduced with male circumcision  Use of condoms  Use screening program (PAP Smear)
 Use of HPV vaccine

Incidence
 Cancer of the Cervix is the commonest malignancy among women in northern Nigeria.  Breast and Cervical Cancer form more than 50% of the cancer burden of the region.  Three to four new cases of cervical cancer are diagnosed every week in ABUTH Shika Zaria  We had 203 cases of cervical cancer in 2007

 This number represents 75% of the total cases of confirmed gynecologic cancers presenting to the unit.  The age distribution was very wide.  Youngest age of presentation was 28years and the oldest was a 90year old with very advanced disease.

 The median age of presentation is 35 years  Majority of the women were married however 3% were single women who have never married and 20% were divorced or widowed.  It affected family women with an average of 5 children.  The commonest mode of presentation is abnormal vaginal bleeding.

Mode of Presentation

 The early symptom of bleeding after intercourse is often ignored by the patients.  Late presentation is the norm.  Signs of late disease with leg swelling and swelling of the groin were often seen.  Only 4 cases (1.9%) out of 203 presented early enough for cure to be achieved.  For 98.5% of cases the disease could best be palliated.

Lady with advanced cancer of the cervix and blockage of intestines. Diversion could only be done with a fine catheter

Advanced Cancer of the Cervix
Lady with advanced cancer of the cervix and blockage of intestines. Diversion could only be done with a fine catheter

Mode of Presentation
 Two hundred cases were not possible to treat surgically.  These cases were treated by heat treatment (radiotherapy)  A quarter of the patients presented with complications of very late disease like leaking urine or faeces, or blockage of their intestines or urinary flow.

Challenges of Management


Poverty results in failure to afford the required treatment.

 The cost per cycle of heat treatment is 25,000 Naira.

 Six to seven cycles are normally required

 Special drugs required to melt out the cancer are very expensive and

toxic. Could be unavailable.

 Follow up of discharged patients is difficult  Many specialists are required to effect treatment in the advanced stages

patients present

The Way Forward
 Cancer of the cervix is about the only human cancer that is almost entirely preventable.  It is also 100% curable if picked at very early stage.  Treatment is cheap and simple in early stages requiring minimal manpower to achieve the high cure rate

The Way Forward
 Cancer of the cervix has an established screening method that works.  Today vaccines are available for primary prevention of cervical cancer.  Theses vaccines are already in use in other places and technology for their production is known.  Countries like India with huge burden of disease have already picked on this opportunity.

Control of Cervical cancer
 Increase in public awareness of the disease.
 Government subsidy and incorporation of

screening program into the primary health care
 Collaboration with NGOs and other institutions for

support .

 Subsidizing cost or provision of free cancer care.
 Infrastructure maintenance and development .

 Training and re-training of personnel.

What Should We Do?
 We need a strategy to reduce to burden of disease in the community through EDUCATION  We need to roll out a reliable screening plan to cover at least 80% of our population  The vaccine for cervical cancer should be part of our immunization plan .

Conclusion
 We should get rid of cervical cancer like other countries have done so we can direct attention on other cancers that have more complex biology.  The longest journey starts with the first step  Lets step out now towards reducing the burden of cervical cancer.

Thank You


				
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posted:11/6/2009
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