International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Umate P et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4873-4878
www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789
DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174992
Original Research Article
Study of clinical profile of cervical cancer
patients: a hospital based study
Preeti Umate, Dhuldev S. Thengal*, Dhundiraj Kurdukar
Department of Obstetrics and Gynecology, Dr. V. M. Government Medical College, Solapur, Maharashtra, India
Received: 02 October 2017
Accepted: 11 October 2017
*Correspondence:
Dr. Dhuldev S. Thengal,
E-mail: vikas_obgy@rediffmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: As a consequence of growing and ageing populations, developing countries are disproportionately
affected by the increasing number of cancers. Though the situation in India is gradually improving there still exists a
disparity between the availability of quality cancer care. With this view, the present study was planned to undertake in
this tertiary care institute to find out symptoms, clinical staging, complications and management of cases of
carcinoma of cervix.
Methods: This was a prospective observational study of carcinoma of cervix carried out at a tertiary care hospital
catering services to the people of Maharashtra and neighbouring states. A thorough history including presenting
complaints, demographic details, educational status and occupational details, details of menstrual and obstetric history
along with any significant past history were recorded on a standard proforma.
Results: Most common symptom was per vaginal bleeding which was found in 29 (69.04%). In the present study
almost two third of cases i.e. 28 (66.6%) had advanced stage (IIB, III, IV) at the time of admission while the number
of cases diagnosed at early stage were only 14 (33.3%). For Wertheim’s hysterectomy, most commonly used
approach was transperitoneal 08 (61.53%) while 05 (38.46%) were operated by extraperitoneal approach. Pelvic
lymph nodes were positive in 03 (23.07%).
Conclusions: A high proportion of patients presented in stages III and IV. This emphasizes the need for early
detection of Gynecological cancers in our population. Accordingly, the importance of detection of the pre-clinical
stage of the diseases by considering the possibility of initiating cost-effective screening measures needs to be
emphasized.
Keywords: Cervical cancer, FIGO Staging, Lymph nodes, Wertheim’s hysterectomy
INTRODUCTION developing countries are disproportionately affected by
the increasing number of cancers.
Cancer is an abnormal mass of tissue, the growth of
which exceeds and is uncoordinated with that of the Cancer is perhaps the most progressive and devastating
normal tissues and persists in the same excessive manner disease posing a threat of mortality to the entire world
after cessation of the stimuli which evoked the change.1 despite significant advances in medical technology for its
diagnosis and treatment.
The burden of cancer is distributed unequally between
developed and developing countries, with particular It is estimated that by the year 2020 there will be almost
cancer types exhibiting different patterns of distribution. 20 million new cases. Worryingly, it is not only in the
As a consequence of growing and ageing populations, number of new cases that will increase but also the
November 2017 · Volume 6 · Issue 11 Page 4873
Umate P et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4873-4878
proportion of new cases from the developing countries The present study was carried out over a period of 2
like India will also rise to around 70%.2 years. Ethical committee clearance was obtained before
starting the study. Informed consent forms were obtained
The most conspicuous feature of the distribution of from all patients. The study included all diagnosed cases
cancers between the sexes is the male predominance of of carcinoma of cervix admitted in Gynecology ward of
lung cancer. Among men, the five most common sites of this hospital.
cancers diagnosed in 2012 were lung, prostate,
colorectum, stomach and liver. Among women, the five
most common sites diagnosed were breast, colorectum,
lung, cervix and stomach. Thus, cervical cancer is the
fourth most common cancer among women worldwide.3
One in every 5th woman in the world suffering from
cervical cancer lives in India4.
Over 80% of women with cervical cancer continue to be
diagnosed at an advanced stage, which is significantly
associated with poor prognosis in developing or less
developed countries.5
Incidence of carcinoma of cervix, invasive type remains
Figure 1: Squamous cell carcinoma.
high in our country possibly as:
A thorough history including presenting complaints,
• Carcinoma cervix is symptomless in early stages
demographic details, educational status and occupational
• Procrastination to the initial symptoms like
details, details of menstrual and obstetric history along
leucorrhoea, post coital bleeding, inter menstrual
with any significant past history were recorded on a
bleeding leading to negligence by patients.
standard proforma. History was followed by a thorough
• Unawareness of symptom complex of carcinoma general, systemic, gynecological and per rectal
cervix and its routine screening tests. examination. Based on these findings, provisional
• Illiteracy among the majority of population. diagnosis was made. The patients were further
• Lack of adequate screening for carcinoma cervix in investigated. Routine investigations were done. HIV
rural areas. testing was also done as per the NACO guidelines.
• Lack of cooperation for mass screening programmes According to the criteria of International Federation of
undertaken by research due to lack of cancer Gynecology and Obstretrics (FIGO), the disease stages
consciousness and fear of disease. were assessed.
Handicaps are further aggravated due to many
superstitious beliefs and inability of patient to tell other
due to shyness. Financial difficulties also prevent these
patients from attending clinic. So, patients come to
hospital when distressing symptoms become unbearable
and also with advance stage of cancer of cervix.
Though the situation in India is gradually improving there
still exists a disparity between the availability of quality
cancer care. With this view, the present study was
planned to undertake in this tertiary care institute to find
out clinical staging, complications and management of
cases of carcinoma of cervix attending tertiary care
hospital. Figure 2: Adenocarcinoma.
Objective of present study was to assess the clinical The diagnosis of carcinoma of cervix was confirmed on
profile of cervical cancer cases including symptoms, histopathology. Ultrasonography and computed
clinical staging, complications and management. tomography was also done in each case.
METHODS Management was done as per the stage of the disease.
Early stage cases (stage IB and IIA) were subjected to
This was a prospective observational study of carcinoma Wertheim’s hysterectomy while cases with advanced
of cervix carried out at a tertiary care hospital catering stage (stage IIB, III and IV) were advised
services to the people of Maharashtra and neighbouring chemoradiation. Technique of Wertheim’s hysterectomy
states.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 6 · Issue 11 Page 4874
Umate P et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4873-4878
(extraperitoneal or transperitoneal) was noted. Intra- age group of 61-70 years. It showed bimodal peak of
operative and postoperative complications were noted. As incidence. Least number i.e. 02 (04.76%) were in the age
per the histopathological report of radical hysterectomy group of >70 years. Youngest case was 34 years of age
specimen and lymph nodes, adjuvant therapy was advised (Non- Immunocompromised) and eldest was 81 years old
in relevant cases. (Table 1).
Most common symptom was per vaginal bleeding which
was found in 29 (69.04%) cases. Post coital bleeding,
intermenstrual bleeding and post menopausal bleeding
were observed as different forms of per vaginal bleeding.
Next common symptom was per vaginal discharge which
was found in 14 (33.33%) cases, of which 08 cases
presented with excessive white per vaginal discharge,
while 06 complaints of foul smelling discharge. Cachexia
was present in 03 (07.14%) cases.
Table 2: Distribution as per symptomatology.
Figure 3: Wertheim’s specimen. No. of
Symptom Percentage
cases
Post coital bleeding 06 14.28
Intermenstrual bleeding 10 23.80
Postmenopausal bleeding 13 30.95
Excessive white PV
08 19.04
discharge
Foul smelling discharge 06 14.28
Cervical Others – Cachexia,
growth
07.14+09.52
Backache, Urinary 03+04+05
+11.90
Complaints
Backache was present in 04 (09.52%) cases. 05 (11.90%)
cases were having urinary complaints in the form of
burning micturation (04 cases) and continuous dribbling
Figure 4: Wertheim’s specimen. of urine (01 case). More than one symptom was present
at the time of diagnosis in 13 (30.95%) cases (Table 2).
Statistical analysis
Table 3: FIGO staging at the time of admission.
Descriptive statistics such as frequency and percentage
was used to present the data. Data was analyzed by using Stage Cases Percentage
SPSS 16.0. IB 06 14.3
IIA 08 19.0
RESULTS IIB 10 23.8
IIIA 09 21.4
During the study period, there were 11,270 gynaec O.P.D IIIB 08 19.0
attendees. Of these, 42 were carcinoma cervix cases. IVA 01 02.4
Total 42 100
Table 1: Age distribution.
In this study almost two third of cases i.e. 28 (66.6%)
Age group (years) No. of cases Percentage were having advanced stage (IIB, III, IV) of cervical
30-40 05 11.90 cancer at the time of diagnosis while only 14 (33.3%)
41-50 15 35.71 cases were diagnosed at early stage of cancer (Table 3).
51-60 08 19.04
61-70 12 28.57 The table shows that, staging changed in 01(02.38%) case
> 70 02 04.76 from stage IIA to stage IIB after examination under
Total 42 100 anaesthesia (EUA) (Table 4).
Out of 42, maximum number i.e.15 (35.71%) were in the Out of 42 cases, histopathologically majority of cases i.e.
age group of 41-50 years followed by 12 (28.57%) in the 40 (95.23%) had Squamous Cell Carcinoma. Only 2
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 6 · Issue 11 Page 4875
Umate P et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4873-4878
(04.76%) were of Adenocarcinoma. In case of two cases Out of these 29 (69.04%), 17 (40.47%) received chemo
of Adenocarcinoma age at the diagnosis was 44 years and radiation therapy while 08 (19.04%) did not take therapy
50 years (Table 5). and 04 (09.52%) were lost to follow up. Hence their
treatment details were not available (Table 7).
Table 4: Clinical staging v/s staging after EUA.
Out of 13 Wertheim’s hysterectomies, 08 (61.535)
Clinical Staging Stage Staging After EUA Wertheim’s were done by transperitoneal approach while
06 IB 06 remaining 05 (38.46%) were done by extraperitoneal
08 IIA 07 approach (Table 8).
10 IIB 11
09 IIIA 09 Table 8: Distribution as per technique of Wertheim’s
08 IIIB 08 hysterectomy.
01 IVA 01
42 Total 42 Technique Cases Percentage
Transperitoneal approach 08 61.53
Table 5: Distribution as per histological type. Extraperitoneal approach 05 38.46
Total 13 100
Histology Cases Percentage
Squamous cell carcinoma 40 95.23 Out of 13 cases, obturator lymph nodes were positive in
Adenocarcinoma 02 04.76 03 cases. Amongst these three, 02 had positive internal
Total 42 100 and external iliac lymph nodes also. All these cases
received postoperative radiotherapy. Common iliac
One case was having continuous dribbling of urine at the lymph nodes were negative in all cases. Para-aortic
time of admission. On examination, it was found to be a lymph nodes were sampled in one suspicious case, but
case of Vesicovaginal fistula. She was stage IVA case. they were negative (Table 9).
One case was in uraemia at the time of admission. She Table 9: Distribution as per histopathological report
was stage IVA case (Table 6). of lymph nodes.
Table 6: Distribution as per complications at the time Cases Positive Negative
Lymph nodes
of admission. (n=13) Nodes Nodes
Obturator 08 03 05
Complications Cases Stage of cancer Internal iliac 07 02 05
VVF (Vesicovaginal External iliac 09 02 07
01 (02.3%) IVA Common iliac 08 00 08
Fistula)
Uraemia 01 (02.3%) IVA Para-aortic 01 00 01
Out of 42, 13 (30.95%) were of early stage (stage IB + DISCUSSION
stage IIA) so Wertheim’s Hysterectomy was done in
these cases. Out of operated, 03 (07.14%) received post Studies conducted by Paul SB et al, Shantla S et al,
operative radiation therapy for positive surgical margins Spartacus RK et al and Devi S et al reported that
and positive pelvic lymph node. Remaining 29 (69.04%) maximum number of cervical cancer cases were from the
were of advanced stage of disease, so chemo radiation age group 41-50 years followed by the age group 51-60
therapy was advised. years.6-9
Table 7: Distribution as per management. The findings of the above studies are comparable with the
findings of present study. In the present study, maximum
Management No. of cases Percentage numbers of cases were in the age group 41-50 years
Wertheim’s hysterectomy 13 30.95 followed by in the age group 61-70 years. The mean age
Adjuvant radiotherapy 03 07.14 of the cervical cancer case was 55.54 years and median
Chemo radiation therapy age was 57.54 years.
29 69.04
advised
Chemo radiation therapy The studies by Narayanswami N et al, Wadhvani R et al,
17 40.47 Kaverappa et al and Devi S et al reported that the
received
Chemo radiation therapy commonest presenting symptom was per vaginal
08 19.04 bleeding, may be either post coital, inter menstrual or
not received
Lost to follow up 04 09.52 postmenopausal.9-12 The next common presenting
symptom was excessive white PV discharge and foul
smelling discharge. These results are comparable with the
present study.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 6 · Issue 11 Page 4876
Umate P et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4873-4878
The studies of Wadhavani R et al, Kaverappa et al and REFERENCES
Singh R et al reported that maximum cases belong to
advanced stage (IIB, III and IV) of disease.11-13 In the 1. Willis RA. Definition of neoplasia. Available at
present study also, two third were having advanced stage http://pathology.med.sumdu.edu.ua/images/stories/le
at the time of diagnosis. So, study results are comparable. cture11_t umores_1.pdf. Accessed on 12 January
2015
The studies carried out by Akhthar PS et al, 2. Senapathy JG, Umadevi P, Kannika PS. The present
Narayanswamy N et al, Wadhvani R et al, Ameen NS et scenario of cervical cancer control and HPV
al and Singh R et al in different settings reported that epidemiology in India: an outline. Asian Pac J
squamous cell type of carcinoma was most Cancer Prev. 2011 Jan 1;12(5):11.
prevalent.10,11,13-15 Above results are comparable with the 3. WHO Cancer Fact Sheet N°297. Available at
present study. The studies of Rajarao P et al, Ameen NS http://www.who.int/mediacentre/factsheets/fs297/en/
et al and Singh R et al and reported that most were treated Accessed on 1 March 2015.
by chemo radiation therapy.13,15,16 Similar findings were 4. Aswathy S, Quereshi MA, Kurian B, Leelamoni K.
noted in the present study. So, the results are comparable. Cervical cancer screening: Current knowledge
andpractice among women in a rural population of
The incidence of lymph node metastasis is directly Kerala, India. Indian J Med Res. 2012;136:205-210.
correlated with the stage of the disease. Lymph node 5. Denny L. Cervical Cancer treatment in Africa. Curr
metastasis, pelvic and/or para-aortic have a major Opin Oncol. 2011;23(5):469-474.
negative impact on the survival of the patient.17,18 6. Paul SB, Tiwary BK, Choudhury AP. Studies on the
Epidemiology of Cervical Cancer in Southern
CONCLUSION Assam. Assam Univ J Sci Tech. 2011 Apr 6;7(1):36-
42.
A high proportion of patients presented in stages III and 7. Shanthala S, Agadi BS, Kulkarni BB, Gai PB. Snap
IV. This emphasizes the need for early detection of shot of epidemiological pattern of cervical cancer
gynecological cancers in our population. Accordingly, the patients reporting to a tertiary cancer care center in
importance of detection of the pre-clinical stage of the North Karnataka, India. Int J Adva Biol Res.
diseases by effective screening measures needs to be 2014;4(2):178-183.
emphasized. Early detection predicts better prognosis. 8. Spartacus RK, Paliwal R, Gaur P, Mutha S, Bhatt Pr,
The most effective ways of preventing and controlling Malavat A. A profile of cervical cancer cases in a
cervical cancer are regular cervical cancer screening government medical college hospital. IOSR-JDMS.
above the age of 30 years. The focus should be on 2015;14(10):37-42.
addressing the underprivileged women. 9. Yumkhaibam SD, Ramalingam M, Singh IY, Singh
TT, Singh LJ, Daru HK et al. Clinicoepidemiological
There are severe constraints concerning organized mass study of cervical carcinoma in Northeast India.
scale screening in India. These could be overcome Indian J Appl Res. 2016;6(8):64-66.
through health education of masses, training of health 10. Swamy MN, Gomathy E, Patil S, Seema BR. The
professionals and changing the health seeking behaviour scenario of cervical cancer in a rural Medical College
of women. Hospital. Int J Pharmaceu Biomed Res. 2012;3(1):1-
4
Cervical cancer is a favorable site for an effective control 11. Wadhwani R, Bamnia R, Meena M. Clinico-
programme with its ease to access and a long latent pathological analysis of cancer cervix in tertiary care
period of intraepithelial neoplasia which is easily centre. J Evol Med Den Sci. 2013 Sep
recognizable by the Pap smear. Thus, there is a need for 30;2(39):7381-85.
initiation of community screening and educational 12. Kaverappa VB, Prakash B, Kulkarni P, Renuka M.
programs through awareness campaigns. Socio-demographic profile of patients with cervical
cancer in a tertiary-care cancer hospital in Mysuru,
The combined approach i.e. education, primary Karnataka. Int J Med Sci Public Health.
prevention (vaccination) and secondary prevention 2015;4:1187-90.
(screening and treatment) can be applied to cancer cervix. 13. Singh R, Shetty N, Naveed M, Pawar SB, Iska S,
Health administration should plan and organize suitable Alugubelli NR. Retrospective analysis of patients
programmes to impart health education for improving the with carcinoma cervix in a rural/semi-urban setting
awareness regarding cervical cancer. HPV vaccine in Western India. Indian J Med Pediatr Oncol.
immunization can be started as pilot project. 2016;37:25-7.
14. Akhtar PS, Hossain MM, Masud ZM, Ruksana N,
Funding: No funding sources Nahar S, Nahar L, et al. A comparative study of
Conflict of interest: None declared result of treatment of cancer cervix patients treated
Ethical approval: The study was approved by the by two separate schedules of radiotherapy.
Institutional Ethics Committee Bangladesh J Obstet Gynecol. 2010;25(2):50-58.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 6 · Issue 11 Page 4877
Umate P et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4873-4878
15. Ameen NS, Helmi ZR. The characteristics women 18. Stehman FB, Bundy BN, Dsaia PJ, Keys HM,
with cervical cancer referred for radiotherapy and /or Larson JE, Flower WC. Carcinoma of the cervix
chemotherapy. Iraqi Postgraduate Med J. treated with radiation therapy: a multivariate analysis
2013;12(3):321-8. of prognostic variables in the gynecologic oncology
16. Rajarao P, Hemanth Kumar B. Study of socio group. Cancer. 1991;67(11):2776-85.
demographic profile of cancer cervix patients in
tertiary care hospital, Karimnagar. Int J Biol Med
Res. 2012;3(4):2306-10. Cite this article as: Umate P, Thengal DS, Kurdukar
17. Berman ML, Keys H, Creasman W, DiSaia P, Bundy D. Study of clinical profile of cervical cancer
B, Blessing J. Survival and pattern of recurrence in patients: a hospital based study. Int J Reprod
cervical cancer metastatic to periaortic lymph nodes Contracept Obstet Gynecol 2017;6:4873-8.
(a GOG study). Gynecol Oncol. 1984;19(1):8-16.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 6 · Issue 11 Page 4878
