1. • 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.

2. 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 Hospital
Gurgaon

3. 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

4. • OPPORTUNISTIC SCREENING
• OPPORTUNISTIC VACCINATION
• Dearth of trained cytologist, pathologist &
gyneccologist at district level.

5. OBJECTIVE
• study the cases of cervical cancer (Rural India)
MANAGED
UNMANAGED
• Analysis for poor outcome
• Shortcoming of our doctors as a community.

6. 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

7. 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

8. RESULTS
PLACE OF
SURGERY
OPERATING
SURGEON
DISCHARGE
SUMMARY
SLIDES /BLOCKS INDICATION OF
SURGERY
PRIVATE: 19
(RURAL)
Govt Hospital:2
SURGEON :18
Surgeon +
Gynecologist: 1
Surgeon : 2
NOT AVAILABLE
No details given
Discharge avail
Not
available
Excessive
bleeding : 15
PMB : 3
Ca Cervix :3

9. 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

10. Analysis
• ALL PATIENTS WERE REFERRED FOR RT ALONE.
• IF RT IS INSUFFICIENT : GIVE CHEMO.
• SIMPLE HYSTERCTOMY WILL BE TAKEN CARE
BY THESE TREATMENT

11. 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.

12. • 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)

13. Discussion
44% refused to take
treatment
WHY?
WHAT WE ARE DOING ABOUT IT

14. 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

16. 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.

17. Discussion
• Cervical Cancer Prevention should be part of
NRHM

18. Discussion
District Cancer Control Program
KERALA MODEL

19. 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

21. • Strong Institutional message and teaching
• Stringent Govt Regulations
• Will of doctor community
• Strong RCC support

22. MOTTO
Every Physician office a cancer control clinic

23. Lets Talk Life

24. Thank you