Cervical cancer in women diagnosed at the National Health Laboratory, Sudan: A call for screening

Abstract

Background: Cancer of the cervix is the second most prevalent cancer of women to date in the Sudan, in a concerted review of the records of the hospital-based cancer registry of the Radiation & Isotope Centre of Khartoum (RICK). However, in spite of a wealth of data, this is the first study to date describing the histopathologic prevalence of cervical cancer in the Sudan.
Objectives: To identify the percentage and clinicopathological pattern of cervical cancer cases diagnosed at Histopathology Department, National Health Laboratory (NHL) in Khartoum, Sudan.
Material and Methods: This is a cross-sectional, descriptive study  conducted at the NHL. All cases with histopathological diagnosis of cervical neoplasm in the period from 2004-2009 were reviewed. Patients’ clinical data were obtained from clinical records. Exclusion criteria included inadequate clinical information and unavailability of both Hematoxylin and Eosin stained (H&E) sections and formalin-fixed paraffin-embedded (FFPE) blocks. The WHO classification of cancer of the cervix (2003) was used to describe disease type. SPSS data analysis was applied.
Results: A total of 287 cases were reviewed and 195 cases were included in the study. The mean of cervical cancer cases diagnosed per year at NHL is 7.9%. The commonest age group affected was patients grouped between 41- 60 years (52%) followed by 61-80 years (26.3%). Histologically, 95.9% of the cases were carcinomas. Squamous cell carcinomas were 90.9%, Adenocarcinomas 4.8%, and other epithelial tumours were 4.3%. Of the Squamous carcinomas, 98.8% were invasive and 1.2% intraepithelial (cervical intraepithelial neoplasia). The majority of case presentations were that of a protruding cervical mass. We noticed the commonest symptom being bleeding per vagina.
Conclusion: To determine the incidence of cervical cancer in the Sudan a national populationbased registry is necessary. The mean age of patients presenting with cervical cancer to NHL is 53.25 years. This is in keeping with the natural history of the human papilloma virus (HPV). The late presentation of patients with aggressive disease necessitates health  education and cervical cancer screening as well as strict guidelines for medical record keeping in line with good medical practices, enabling good data collection for the newly established population-based cancer registry.

Keywords: HPV, invasive squamous cell carcinoma.