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• I am not here to discuss my data of success i.e how good surgeon am I or how many cases our cancer centre has treated.
• This data gives me sense of hopelessness that where I am standing and what I am doing
• This is data of pitiable conditions faced by our women.
• This is data of poor education imparted to our doctors and money stinking in us.
Cervical Cancer Management in Rural India: Are we really living in 21st century or need to focus on education of our Doctors
Dr Sujata Mittal Dept of Gyne Oncology
Paras HospitalGurgaon
Cervical Cancer: Indian Scenario
Commonest Gynecological Cancer: PREVENTABLE : yet not preventable in India
HBCR showed 69% -83% had regional disease at the time of presentation
• OPPORTUNISTIC SCREENING
• OPPORTUNISTIC VACCINATION
• Dearth of trained cytologist, pathologist & gyneccologist at district level.
OBJECTIVE• study the cases of cervical cancer (Rural India) MANAGED UNMANAGED • Analysis for poor outcome
• Shortcoming of our doctors as a community.
Methods• Retrospective study from 2008 -2013
• 218 cases of cervical cancer
• Resultant outcome in terms of treatment /absence of treatment
• Reasons for not taking treatment
• Analysis of 21 cases of simple hysterectomy
Results
• 44% refused to take treatment
• 29.8% took complete treatment
• 20.65% opted for other hospital
• 6.5% took partial treatment
• 9.7% had simple hysterectomy for invasive disease
RESULTS
PLACE OF SURGERY
OPERATING SURGEON
DISCHARGE SUMMARY
SLIDES /BLOCKS INDICATION OF SURGERY
PRIVATE: 19(RURAL)Govt Hospital:2
SURGEON :18Surgeon + Gynecologist: 1Surgeon : 2
NOT AVAILABLENo details given
Discharge avail
Not available
Excessive bleeding : 15 PMB : 3 Ca Cervix :3
Analysis of simple hysterectomy
PREOP EVALUATION(HPR/STAGING)
POST OP HPR
3 CASES—2 GOVT 1 PVT (No HPR, Staging)Only clinical diagnosis
ALL 21 CASES
Analysis
• ALL PATIENTS WERE REFERRED FOR RT ALONE.
• IF RT IS INSUFFICIENT : GIVE CHEMO.
• SIMPLE HYSTERCTOMY WILL BE TAKEN CARE BY THESE TREATMENT
Discussion
• SURGEONS MORE DARING In 1 case operated at Govt Hospital, Ca cervix involved body uterus, rt ureter &
anterior wall of rectum. Simple hysterectomy with rt ureteric stenting
with partial resection of anterior wall of rectum was done.
• WHY & WHAT M.S/M.D GYNEC ARE DOING ? 1. Number of deliveries are decreasing. (JANANI SURAKSHA YOJNA)
2. Has not seen much cases being operated in Institutions (LACK OF PROPER TRAINING IN P.G.) (MORE EMPHASIS ON OBSTETRIC WORK)
Discussion
44% refused to take treatment
WHY?WHAT WE ARE DOING ABOUT IT
Reasons for not taking Rx• Financial stress
• Lack of insurance
• Distance to be covered for treatment
• Loss of daily wages
• Non availability of blood donors
• Quacks/Alternative system of medicine
BUT
Districts in Rajasthan are poorly equipped in terms of man power, technology and will.
Even PAP is not done in Govt Hospital due to lack of availability of resources in terms of equipment and man power.
Discussion
•Cervical Cancer Prevention should be part of
NRHM
Discussion
District Cancer Control Program
KERALA MODEL
Discussion
• Training in Medical Colleges• Special Training for doctors at PHC,CHC,DH (VIA,
VILI)• Special training for Aanganwadi, health workers.
(VIA, VILI)• Incorporation of Cancer Prevention in
Reproductive & Child Health • Vaccine should be part of National Vaccination
Program
• Strong Institutional message and teaching
• Stringent Govt Regulations
• Will of doctor community
• Strong RCC support
MOTTO
Every Physician office a cancer control clinic
Lets Talk Life
Thank you