Abstract:

A prospective cross sectional study was done at Muleba District where a total of 370 women aged above 15 years were enrolled in the study. The majority of attendees 206 (55.7%) were not aware of the disease. Regarding the awareness on risk factors the majority, 285 respondents (77.0%) were not aware of risk factors. This applied also to the symptoms where 249 (67.3%) of the studied population were not aware of the symptoms. Basing on the level of education among (49) secondary school attendees, majority 67 (54%), are aware of the disease, similar picture is in the study population with college education majority 26 (65.0%) are also aware, the same applied to the higher leaning where 7 (85.5%) were aware of the disease and those with primary education and those who did not attend at school were less aware of the disease. So education level has an effect in terms of awareness of cervical carcinoma. The source of information regarding cervical carcinoma among the attendees, the majority (26.2%) got the information about the cervical cancer from health facility, followed by radio and television (14.3%). Therefore we suggest that health education should be given through communication media to the women about the risk factors, symptoms and signs to minimize chances of getting the disease.

Diagnosis of cercal cancer is based on the history, physical examination and supporting lab investigations plus histology of cervical biopsies help confirm its diagnosis. Because women are screened routinely, the most common finding is an abnormal Pap smear result. Clinically, the first symptom is abnormal vaginal bleeding, usually postcoital. Vaginal discomfort, malodorous discharge, and dysuria and not uncommon. The tumor grows by extending upward to the endometrial cavity, downward to the vagina, and laterally to the pelvic wall. It can invade the bladder and rectum directly. Symptoms that can evolve, such as constipation, hematuria, and ureteral obstruction with or without hydroureter or hydronephrosis, reflect local organ involvement. The triad of leg edema, pain, and hydronephrosis suggests pelvic wall involvement. The common sites for distant metastasis include extra pelvic lymph nodes, liver, lung and bone. In patients with early stage cervical cancer, physical examination findings can be relatively normal. As the disease progresses, the cervix may become abnormal in appearance, with gross erosion, ulcer, or mass. These abnormalities can extend to be vagina. Rectal examination may reveal an external mass or gross blood from tumor erosion. Bimanual examination findings often reveal pelvic metastasis. Leg edema suggests lymphatic/vascular obstruction from tumor. If the disease involves the liver, some patients develop hepatomegaly. Pulmonary metastasis usually is difficult to detect upon physical examination unless pleural effusion or bronchial obstruction becomes apparent.

Just like any other disease, cancer of the cervix is not without differential diagnoses. These include; cervicitis, endometrial carcinoma, pelvic inflammatory disease, uterine cancer, vaginitis, vaginal cancer, metastatic cancer to the cervix, granulomatous lesions of the cervix e.g. tuberculosis, Schistosomiasis, cervical wart etc. For primary prevention, avoidance of repeated infections and smoking, as well as a high antioxidant intake may be beneficial. Vaccines against HPV also have promise for the future, but a better understanding of the mechanisms underlying spontaneous clearance of both infection and cervical intraepithelial neoplasia (CIN) of different grades is also essential for optimal intervention. For screening, the choice of whether the Pap smear, HPV testing or some form of visual inspection are utilized depends on the resources which are available, all approaches having their own advantages and disadvantages, but with similar sensitivity and specificity.

A focus on high risk groups like sex workers might be warranted where financial and technical support is limited. If cervical intraepithelial neoplasias are detected then cryotherapy or the loop electrosurgical excision procedure (LEEP) are effective for their removal.

Control of cancer of the cervix, however, demands that a comprehensive approach to screening and management is adopted, necessitating major training of personnel and provision of appropriate resources.