A six-year study of the clinical presentation of cervical cancer and the management challenges encountered at a state teaching hospital in southeast Nigeria.
A six-year study of the clinical presentation of cervical cancer and the management challenges encountered at a state teaching hospital in southeast Nigeria.
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DOI：
10.4137/cmo.s12017
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Edegbe FO
中科院分区：
文献类型：
--
作者：
Eze JN;Emeka-Irem EN;Edegbe FO
宫颈癌仍然是发展中国家贫穷农村社区妇女癌症相关死亡率的主要原因。本研究的目的是建立宫颈癌的临床表现和管理遇到的挑战，在阿巴卡利基，东南尼日利亚，以期找到干预策略。本研究是一项回顾性描述性评估的情况下，临床诊断的宫颈癌管理在一个国家教学医院超过六年。在管理的76例病例中，61例（80.3%）病例记录可用于研究。患者的平均年龄和产次分别为53.8岁和6.8岁。大多数人（75.4%）是文盲。所有人都结过婚，但42.6%的人是寡妇。主要职业是农业或小买卖。1例患者（1.6%）一生中只做过一次巴氏涂片检查。主要主诉为阴道异常出血（86.9%）、阴道分泌物增多（41.0%）和体重下降。20例患者（32.8%）在分期前失访。其余41例患者中，16例（39.0%）为III期疾病，17.1%为IV期。15例（24.6%）晚期疾病患者接受转诊，并转诊接受放射治疗。那些拒绝的人在要求下出院回家，但有4人（9.8%）在医院死亡。没有来自转诊患者的反馈确认他们去了并从转诊中受益。介绍遵循了已知的趋势。文盲、贫穷、早婚、高生育率、寡妇、不使用筛查方法、迟交、不接受转诊以及转诊后缺乏沟通是遇到的一些主要挑战。这些问题突出表明，需要开展健康教育和提高认识，增强妇女的教育和经济权能，立法禁止早婚和保护寡妇，并建立一个人员配备和设备齐全的专门妇科肿瘤科，以防止进一步转诊。
Cervical cancer is still a major contributor to cancer-related mortality amongst women living in poor, rural communities of developing countries. The objective of this study is to establish the clinical presentation of cervical cancer and the management challenges encountered in Abakaliki, southeast Nigeria, with a view to finding intervention strategies. This study is a retrospective descriptive assessment of cases of clinically diagnosed cervical cancer managed at a state teaching hospital over six years. Of 76 cases managed, 61 (80.3%) cases notes were available for study. The mean age and parity of patients were 53.8 years and 6.8 years, respectively. The majority (75.4%) were illiterate. All had been married, but 42.6% were widowed. The main occupations were farming or petty trading. One patient (1.6%) had had a single Pap smear in her life. The major presenting complaints were abnormal vaginal bleeding (86.9%), offensive vaginal discharge (41.0%), and weight loss. Twenty patients (32.8%) were lost to follow-up prior to staging. Of the remaining 41 patients, 16 (39.0%) had stage III disease and 17.1% stage IV. Fifteen patients (24.6%) with late stage disease accepted referral, and were referred for radiotherapy. Those who declined were discharged home on request, though 4 (9.8%) died in the hospital. There was no feedback from referred patients confirming that they went and benefitted from the referral. The presentation followed known trends. Illiteracy, poverty, early marriages, high parity, widowhood, non-use of screening methods, late presentation, non-acceptance of referral, and lack of communication after referral were some of the major challenges encountered. These underscore the needs for health education and awareness creation, women educational and economic empowerment, legislation against early marriages and in protection of widows, and creation of a well-staffed and well-equipped dedicated gynecologic oncology unit to forestall further referral.