Cervical Cancer In Northern Nigeria

Document Sample
Cervical Cancer In Northern Nigeria Powered By Docstoc
Senior Lecturer/ Consultant ABUTH Zaria

 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

 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 .

 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

Shared By: