cervical cancer management in developing countries

• I am not here to discuss my data of success i.e how good surgeon am I or how many cases our cancer centre has treated.

• This data gives me sense of hopelessness that where I am standing and what I am doing

• This is data of pitiable conditions faced by our women.

• This is data of poor education imparted to our doctors and money stinking in us.

Cervical Cancer Management in Rural India: Are we really living in 21st century or need to focus on education of our Doctors

Dr Sujata Mittal Dept of Gyne Oncology

Paras HospitalGurgaon

Cervical Cancer: Indian Scenario

Commonest Gynecological Cancer: PREVENTABLE : yet not preventable in India

HBCR showed 69% -83% had regional disease at the time of presentation

• OPPORTUNISTIC SCREENING

• OPPORTUNISTIC VACCINATION

• Dearth of trained cytologist, pathologist & gyneccologist at district level.

OBJECTIVE• study the cases of cervical cancer (Rural India) MANAGED UNMANAGED • Analysis for poor outcome

• Shortcoming of our doctors as a community.

Methods• Retrospective study from 2008 -2013

• 218 cases of cervical cancer

• Resultant outcome in terms of treatment /absence of treatment

• Reasons for not taking treatment

• Analysis of 21 cases of simple hysterectomy

Results

• 44% refused to take treatment

• 29.8% took complete treatment

• 20.65% opted for other hospital

• 6.5% took partial treatment

• 9.7% had simple hysterectomy for invasive disease

RESULTS

PLACE OF SURGERY

OPERATING SURGEON

DISCHARGE SUMMARY

SLIDES /BLOCKS INDICATION OF SURGERY

PRIVATE: 19(RURAL)Govt Hospital:2

SURGEON :18Surgeon + Gynecologist: 1Surgeon : 2

NOT AVAILABLENo details given

Discharge avail

Not available

Excessive bleeding : 15 PMB : 3 Ca Cervix :3

Analysis of simple hysterectomy

PREOP EVALUATION(HPR/STAGING)

POST OP HPR

3 CASES—2 GOVT 1 PVT (No HPR, Staging)Only clinical diagnosis

ALL 21 CASES

Analysis

• ALL PATIENTS WERE REFERRED FOR RT ALONE.

• IF RT IS INSUFFICIENT : GIVE CHEMO.

• SIMPLE HYSTERCTOMY WILL BE TAKEN CARE BY THESE TREATMENT

Discussion

• SURGEONS MORE DARING In 1 case operated at Govt Hospital, Ca cervix involved body uterus, rt ureter &

anterior wall of rectum. Simple hysterectomy with rt ureteric stenting

with partial resection of anterior wall of rectum was done.

• WHY & WHAT M.S/M.D GYNEC ARE DOING ? 1. Number of deliveries are decreasing. (JANANI SURAKSHA YOJNA)

2. Has not seen much cases being operated in Institutions (LACK OF PROPER TRAINING IN P.G.) (MORE EMPHASIS ON OBSTETRIC WORK)

Discussion

44% refused to take treatment

WHY?WHAT WE ARE DOING ABOUT IT

Reasons for not taking Rx• Financial stress

• Lack of insurance

• Distance to be covered for treatment

• Loss of daily wages

• Non availability of blood donors

• Quacks/Alternative system of medicine

BUT

Districts in Rajasthan are poorly equipped in terms of man power, technology and will.

Even PAP is not done in Govt Hospital due to lack of availability of resources in terms of equipment and man power.

Discussion

•Cervical Cancer Prevention should be part of

NRHM

Discussion

District Cancer Control Program

KERALA MODEL

Discussion

• Training in Medical Colleges• Special Training for doctors at PHC,CHC,DH (VIA,

VILI)• Special training for Aanganwadi, health workers.

(VIA, VILI)• Incorporation of Cancer Prevention in

Reproductive & Child Health • Vaccine should be part of National Vaccination

Program

• Strong Institutional message and teaching

• Stringent Govt Regulations

• Will of doctor community

• Strong RCC support

MOTTO

Every Physician office a cancer control clinic

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Thank you