Prevalence of prognostic factors in patients with cervical cancer operated at Queen Elizabeth Central Hospital
Date
21-09-15
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kamuzu University of Health Sciences
Abstract
1.0 Introduction
Cervical cancer is the 4
the
leading cancer in the world, with a global incidence of 6.6 percent
and mortality rate of 7.5 percent of mortality. In Africa, the incidence and mortality is higher
at 40.1 percent and 30 percent respectively [1].
Malawi has a population of approximately 19 million people, with 49.5 percent males and 50.7
percent females. This corresponds to 45 percent of reproductive-aged women, who are at risk
from cervical cancer. Cervical cancer is the leading cancer in women, with an age-standardized
rate (ASR) incidence and mortality of 79.5 and 49.8 per 100,000 population, respectively [2].
The median survival time from the time of presentation is 10 months with a 5-year survival
rate of 2.9 percent [2]. This survival rate is low compared to other regions like Uganda and
Zimbabwe, where 5-year survival is 17.7% and 26.5%, respectively [3]. The main risks for a
high cervical cancer incidence and mortality are high prevalence of Human immunodeficiency
Virus [HIV] at 10.6%, human papilloma virus [HPV] at33.6%, inadequate screening and
treatment services for precancerous lesion, late diagnosis limited access to timely standard
treatment of cancer and palliative care [4].
Cervical cancer survival and recurrence is dependent on a number of factors described as
prognostic factors. These prognostic factors include stage of cervical cancer, lymph node
metastases, presence of parametrial invasion and lymphovascular space invasion. These
prognostic factors playa significant factor in management of cervical cancer as their presence
or absence will determine the course of treatment.
Several strategies have been implemented to reduce cervical cancer-related deaths and increase
the 5-year survival rates. The Malawi cervical cancer Service delivery guidelines state that the
following basic elements are needed to provide an efficient cervical cancer prevention
program: logistics and supply management of equipment and supplies for survival cancer
screening and treatment,
diagnostic services for clients who are cancer suspects, treatment services for clients
diagnosed with cervical cancer, training of health care providers in screening and treatment
modalities, quality assurance ,monitoring and evaluation, infection prevention and control,
referrals and linkages and management of other cervical conditions including STI's [5].
How this sentence starts does not flow from the one before it This includes, increasing the
number of screening sites, increasing the number of treatment sites and availability of other
treatment modules post-surgery. From 2011 and 2015 the number of cervical cancer screening
sites, number of women screened, and coverage increased from 75 to 130, 15,331 to 49,301
and 9.3% to 26.5 percent respectively [6]. Currently there is a total of 357 VIA (visual
inspection of the cervix with acetic acid) screening sites of which 211 are active [5].
15-Sep-2021
Proposal on Prevalence of prognostic factors in patients with cervical cancer operated at
QECH. Version 1.21 126/74/2021
6
There are 2 facilities Queen Elizabeth Central Hospital and Kamuzu Central Hospital that
provide specialized cervical cancer care. To expand the portfolio of services available to
cervical cancer patients, the Ministry of Health through Queen Elizabeth Central Hospital
agreed with Médecins Sans Frontières (MSF) to establish a comprehensive cancer services
center to serve the southern region. This facility provides diagnostic and treatment services
such as surgery and chemotherapy in collaboration with the Oncology Department