CANCER OF THE CERVIX

This is the most common gynaecological cancer.

Cancer of the cervix uteri is the fourth most common cancer among women worldwide and the leading cause of gynecologic cancer death in low- to middle-income countries.

WHO estimates that in 2014 approximately 3915 Ugandan women were diagnosed with cervical cancer and that 2160 died from the disease

3 in every 10 women are carrying the virus that predisposes one to cervical cancer in Uganda and 80% ( eight in ten women) of the women who present with cervical cancer have advanced stage disease. [Carolyn Nakisige 2017]

Risk factors

  • Early age of first coitus
  • Multiple sexual partners
  • Having spouses with multiple sexual partners
  • High parity
  • Infection with human papilloma virus (HPV)
  • Infection with Herpes simplex type II.

Clinical Features

  • Commonest in age group 30 and above.
  • There is post-coital bleeding.
  • There is post-menopausal bleeding.
  • There is foul smelling vaginal discharge.
  • There is intermenstrual PV bleeding.
  • Many patients present late with advanced disease.
  • Pain, anaemia, cachexia are late presenting features.
  • Diagnosis is confirmed by histology.

Investigations

  • Speculum examination shows easily bleeding lesion on the cervix
  • Haemoglobin
  • Biopsy
  • A high index of suspicion is essential as early detection is important

Management

  • Provide general supportive care, e.g., correction of anaemia.
  • Undertake examination under anaesthesia for staging and biopsy of the lesion, for confirmation by histology.
  • Provide supportive treatment, surgery, and/or radiotherapy.
  • Refer to a specialist as appropriate.
  • If histology confirms malignancy, admit for investigations.

Prevention

  • Avoid risk factors listed above.
  • Pap smear every 3 years for early detection.
  • Visual inspection (of cervix) with acetic acid (VIA) or Lugol’s iodine (VILI) are simple screening methods that can be used for all women from sexual debut.
  • HPV vaccine before sexual debut and for those HPV negative.