Prevalence of prognostic factors in patients with cervical cancer operated at Queen Elizabeth Central Hospital

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Date
21-09-15
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Kamuzu University of Health Sciences
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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
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