Downstaging of carcinoma cervix: yet to reach the unreached

Kavita Mahadevappa, Naveen Prasanna, Shobha Bembalgi, Sharanabasav Murugendrayya Choukimath


Background: To know the incidence, presenting symptoms and stages of carcinoma cervix in the patients visiting KIMS, Hubli, Karnataka in the year 2014.

Methods: This is a prospective cross-sectional study from January 2014 to December 2014 in Karnataka Institute of Medical Sciences, Karnataka. All patients attending the gynaecological OPD were included in the study. After taking detailed history, patients underwent general physical examination, per speculum and pelvic examination. Patients were divided into 3 groups based on the per speculum and pelvic examination. Group 1 – only PAP smear was taken in women with normal cervix. Group 2 – PAP smear, visual inspection of cervix with acetic acid and biopsy was taken in women with abnormal cervix. Group 3 – only Cervical biopsy was taken and clinical staging was done in women with a suspicious cervix.

Results: Total of 8053 patients were screened and examined for carcinoma cervix. A total of 14(0.17%) preinvasive lesions and 85(1.05%) invasive lesions were detected. Out of 85 invasive lesions, the most common pathology was squamous cell carcinomas in 78 (91.76%) patients, adenocarcinomas in 6 (7.05%) patients and adenosquamous carcinoma in 1(1.17%) patient. The most common symptoms of carcinoma cervix were WDPV- 48 (56.4%), Irregular vaginal bleeding- 19 (22.3%), postmenopausal bleeding- 10 (11.7%) and in advanced cases, VVF – 5 (0.05%), RVF- 1 (0.01%) and Uraemia - 2 (0.02%). Most of the patients examined were having disease in stage III -51 (60%) cases, stage IV – 26 (30.58%) cases, stage I -5 (5.8%) cases and stage II – 3 (3.52%) cases.

Conclusions: Approximately one in every 100 patients examined in OPD, turned out to be a case of carcinoma cervix, out of which more than 90% patients were diagnosed to be in advanced stage. This huge burden of cases raises the question about screening of carcinoma cervix in rural areas, which needs to be improved. Hence lot has to be done than said, so that screening program of cancer cervix reaches the unreached.


Cervical cancer, Downstaging of cancer cervix, PAP smear, Suspicious cervix, Cervical biopsy

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Sankaranarayanan R, Ferlay J. Worldwide burden of gynecological cancer: The size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006;20:207-25.

WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Summary report on HPV and cervical cancer statistics in India. 2007. Available from: Last Assessed on 2008 May 1.

Arbyn M, Castellsague X, DeSanjose S. Worldwide burden of cervical cancer. Ann Oncol. 2011;22:2675-86.

National Centre for Disease Informatics Research, National Cancer Registry Programme, ICMR Three Year Report of Population Based Registries, 2009–2011 Bangalore, India: NCDIR-NCRP (ICMR;). 2014

ICO Information Centre on HPV and cancer. Human Papillomavirus and Related Diseases in India. 2014.

Sreedevi A, Javed R, Dinesh A. Epidemiology of cervical cancer with special focus on India. Int J Womens Health. 2015;7:405-14.

Jissa VT, Nea M, Matti H. Sociodemograhic and reproductive risk factors for cervical cancer-a large prospective cohort study from Rural India. Asian Pac J Cancer Prev. 2012;13:2991-5.

Misra JS, Srivastava S, Singh U. Risk-factors and strategies for control of carcinoma cervix in India: hospital based cytological screening experience of 35 years. Indian J Cancer. 2009;46(2):155-9.

Gakidou E, Stella N, Ziad O. Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PloS Med. 2009;5:e132.

Aswathy S, Quereshi MA, Kurian B, Leelamoni K. Cervical cancer screening: current knowledge and practice among women in a rural population of Kerala, India. Indian J Med Res. 2012;136(2):205-10.

Sankaranarayanan R, Nene BM, Shastri SS. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360:1385-94.

Sankaranarayanan R, Esmy PO, Ramkumar R. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu: a cluster-randomised trial. Lancet. 2007;370:398-406.

Dutta S, Biswas N, Mukheriee G. Evaluation of sociodemographic factors for non compliance to treatment in locally advanced cases of cancer cervix in a rural medical college hospital in India. Indian J of Palliat Care. 2013;19(3):158-65.

Yeole BB, Kumar AV, Kurkureet A, Sunny L. Population-based survival from cancers of breast, cervix and ovary in women in Mumbai. Asian Pac J Cancer Prev. 2004;5:308-15.

Nandakumar A, Ramnath T, Chaturvedi M. The magnitude of cancer cervix in India. Indian J Med Res. 2009;130(3):219-21.

Satija A. Cervical cancer in India. South Asia centre for chronic disease. [Accessed February16, 2014]. Available from: cervical_cancer.pdf.

National Centre for Disease Informatics Research, National Cancer Registry Programme, ICMR Time Trends in Cancer Incidence Rates, 1982–2010 Bangalore, India: NCDIR-NCRP (ICMR;). 2013.

Dhillon PK, Yeole BB, Dikshit R. Trends in breast, ovarian and cervical cancer incidence in Mumbai, India over a 30-year period, 1976–2005: an age-period-cohort analysis. Br J Cancer. 2011;105(5):723-30.

Chhabra S, Bhavani M, Mahajan N. Cervical cancer in Indian rural women: trends over two decades. J Obstet Gynaecol. 2010;30(7):725-8.

Hussain MA, Pati S, Swain S. Pattern and trends of cancer in Odisha, India: a retrospective study.Asian Pac J Cancer Prev. 2012;13(12):6333-6.

Seema P, Paul B, Boffetta P. Meta analysis of social inequality and the risk of cervical cancer. Int J Cancer. 2003;105:687-91.