Riaz Ahmad Bhutta ( Departments of Pathology, Nishtar Medical College, Multan. )
Umar All Khan ( Departments of Physiology, Nishtar Medical College, Multan. )
Muhammad All Choudhry ( Departments of Students, IV year Nishtar Medical College, Multan. )
Asad Riaz ( Departments of II year, Nishtar Medical College, Multan. )
Carcinoma cervix was a leading cause of death in women in USA, fifty years ago1. Terris and Oalmam2 and Ratkin3have repeatedly demonstrated a relationship between several parameters of sexual activity and carcinoma cervix. Epidemiological data suggested a sexually transmitted agent as risk factor based on, early age at first intercourse, multiple sexual partners and a male partner with multiple sexual partners4,5 in causation of carcinoma cervix. Human papilloma virus is currently considered an important factor in cervical oncogenesis6. Host gene mutations are also found to be associated with carcinoma cervix7. Other potential risk factors are use of oral contraceptives8-10, cigarette smoking, genital infections and lack of circumcision in male sexual partner4,5 We conducted a study to see the prevalence of carcinoma cervix in Multan.
Material, Methods and Results
A total of 244 specimens received at Department of Pathology, Nishtar Medical College, Multan during years 1987-1996 were considered in this study. The samples consisted of either biopsies or hysterectomy specimen which were stained with Hematoxylin and Eosin. The specimens were histologically determined and were divided according to age and type of carcinoma.
Of the total squamous cell carcinoma cervix was seen in 94.2% (n=230), adenocarcinoma in 4.5% (n=1 1) and carcinoma in situ in only 0.8% (n=2) cases, while remaining 0.40% cases had other types of carcinoma. Of 230 cases of squamous cell carcinoma, 150 were well differentiated (65.2%); 29 cases were moderately differentiated (12.6%) and 51 were poorly differentiated (22.1%). Peak incidence of carcinoma cervix was found in 41-50 years (35.2%) followed by 5 1-60 years (25.8%) and 3 1-40 years (20.5%). Disease was infrequent in 61 years and above.
No form of cancer better documents the remarkable effects of prevention, early diagnosis and curative therapy on the mortality rate than carcinoma cervix1. Our results show that 94.2% cases had squamous cell carcinoma which is similar to previous report of PMRC11, while carcinoma in situ was found in 0.8% cases. In developed countries the rate of occurrence and mortality of carcinoma cervix has dropped by 40% in the last few years12,13. Van Nagell et al14 and Ratman M. et al15 reported that 95% of squamous cell carcinomas are well and moderately differentiated and just a small subset of carcinoma cervix (<5%) fall in poorly differentiated type. Our results show that 77.8% cases are of well and moderately differented type and a high percentage of poorly differentiated type of carcinoma cervix (22.7%).
The reason for drop in the occurrence of carcinoma cervix and low percentage of poorly differentiated carcinoma cervix in modern world is because PAP smear screening is done as a routine procedure. Using PAP’s smear abnormal cells can be detected on cytological examination quite early16.
In the present study the peak incidence of carcinoma cervix was found in age group 41-50 years. This observation is similar to those of Roohi and Sahi17, but differ from Perveen et al18, who reported more cases in early age group. The number of cases after the age of 61 years and above are less in our study as compared to those of Dumn and Schweitzer12. This difference may be due to decreased life expecting in our country.
High incidence of cervical cancer in our country is mostly because of delayed diagnosis. For early detection of the disease it is recommended that the gynecologists and obstetricians should do the PAP smear screening of all women visiting them and women should be educated about the value and harmlessness of PAP smear and its high yield in early detection of any viral infection, dysplasia or neoplasia.
1. Cortin, Kumar, Robiun. Pathologic basis of disease. 5th ed. Philadelphia, W.B. Saunders Co., 1994.
2. Terris M, Oalmam MC. Carcinoma of cervix: an epidemiologic study. JAMA., 1960;124: 1847.
3. Ratkin ID. Relation of addlescent coitus to cervical cancer risk. JAMA., 1962:179:86.
4. Koutsly LA. A cohort study of the risk of cervical intracpithelial neoplasia grade 2 or 3 in relation to papilloma virus infection. N.Engl.J.Med., 1992:327:1272-78.
5. Flerrero R. Sexual behavior venereal diseases, hygiene practices and invasive cervical cancer in a high risk population. Cancer, 1990:65:380-86.
6. ZUR-Hausen H, Schnider A. The role of human papilloma viruses in human urogenital cancer. In: Salzman, N, Howley P (ed): The papovaviridar. New York, Plemum Press, 1987, pp. 245-63.
7. Crook 1, Vousdan K1-l. Properties of P53 mutations detected in primary and secondary cervical cancers suggest mechanisms of metastasis and involvement of environmental carcinogens. Embo J., 1992:11:3935-40.
8. Stern E, Forsyth AB, Youkales L, et al. Steroid contraceptive use and cervical dysplasia: Increased risk of progression. Science, 1977:196:1460.
9. Periitz E, Rarnchoran S. Frank F, et al. The incidence of cervical cancer and duration of contraceptive use. Am .J.Epidemiol., 1977:106:162.
10. Meiseb A, Begin R, Schneider V. Dysplasias of uterine cervix, epideiniological aspects: role of age at first coitus and use of oral contraceptives. Cancer: 1977;40:3076.
11. Pakistan Medical Research Council. Malignant tumours: reports of multicentre study, 1977-80, Islamabad, PMRC, 1982.
12. Dum JE. Schweitzer V. The relationship of cervical cytology to the incidence of invasive cervical cancer and mortality in Alameda County, California 1960 to 1974. Am .J.Obstet.Gynecol., 1981:139:868.
13. Silverberg E, Luberto J. Cancer statistics. Cancer, 1981:39:1.
14. Van-Nagell JR. Small cell cancer of uterine cervix. Cancer, 1997:40:2243-49.
15. Ratman M. Prognostic factors in carcinoma cervix: implications in staging and management. Cancer, 1981:48:560.
16. Kurman R (ed). Blaustein’s Pathology of female genital tract, 4th ed., NewYork, Springer-Verlag, 1994.
17. Perveen SA, Akhtar N, Shahid MA. Radiotherapy of cervical cancer: experience with combined brachy therapy and exter nal beam therapy. Pak.J.Med.Res., 1995:34:95-98.
18. Roohi M, Sahi Si. Incidence of cervical intraepithelial neoplasia in Faisalabad. Pak.J.Med.Res., 1993:32:162-65.