ANALYSES OF CERVICAL CANCER IN RAJKOT POPULATION

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1 Electronic Journal of Pharmacology and Therapy Vol 4, (2011) ISSN: (Available online at wwwtcrjournalscom) Clinical Article ndexed in: ProQuest database Abstract, USA (ProQuest Science Journals, Health and Medical complete), EBSCO databases (USA), Indian Science Abstract, Medical and Aromatic Plant Abstract, New Delhi ANALYSES OF CERVICAL CANCER IN RAJKOT POPULATION DHRUVA, G A, AGRAVAT, A H, AND BHOJANI, K R Department of Pathology, Pandit Deendyal Upadhya Medical College, Rajkot E mail: gadhruva@gmailcom Received: July10, 2011; Accepted: August 11, 2011 Abstract: Cervical malignancy is the second most common cancer in women worldwide, In present study, results of 400 Pap smears are analyzed, which had been examined in cytology section (Department of Pathology, PDU Medical College, Rajkot) during 2 years time duration ( ) All cervical smears collected and stained by Pap staining method The smears were reported using The Bethesda system 2001 The commonest complaints observed during study were abnormal vaginal discharge (465%) and menstrual abnormalities (205%) According to classification of smears by Bethesda system, 18(45%) were unsatisfactory, 148(37%) were normal, 07(125%) had atrophic changes, 190(475%) were inflammatory, 03(075%) were ASCUS, 20(5%) were LSIL, 11(275%) were HSIL and 03(075%) were squamous cell carcinoma, majority patients had 2 children 144(36%) and study showed that high parity was associated with higher occurrence of premalignant and malignant lesions of cervix Pap smear is a simple, cheap, safe and practical diagnostic tool for early detection of cervical cancer in high risk group population and therefore should be established as routine screening procedurepap smear is a valuable tool for investigation as a screening procedure in asymptomatic women and as a diagnostic procedure in symptomatic womenit also has an important role in diagnosis of inflammatory lesions including the identification of causative organism, atrophic changes, changes of radiation therapy and some rare tumorsit is recommended that reporting should be done by The Bethesda System as it improves the reproducibility and helps in identification of ASCUS and AGUS lesions and plays a key role to diagnose various intraepithelial lesions and invasive lesions at an early stage and manage them properly Key words: Cervical smears, Pap stain, Bethesda? INTRODUCTION Cervical malignancy is the second most common cancer in women worldwide following breast cancer, and the leading cause of death by cancer It is one of the most preventable and curable of all cancers The Papanicolaou smear is most useful tool for detection of abnormal cells that may be due to preneoplastic lesions or frank malignancy The test is named after Dr George Papanicolaou who introduced it in 1941[1] The easy accessibility of the cervix and the propensity of the cancer cells to exfoliate from its surface have enabled us to study the process of malignant transformation in the cervix in very early stage [2] Currently Pap test has gained wide popularity not only as a diagnostic test in patients but also 15

2 as an important routine screening test in asymptomatic women due to its simplicity and cost effectiveness [3] MATERIAL AND METHODS In present study, results of 400 Pap smears are analyzed,which had been examined in cytology section (Department of Pathology, PDU Medical College, Rajkot) during 2 years time duration ( ) All of the patients had some relevant gynecological complaints who presented to gynecology OPD The age of the screened patients was in the range of years Cervical smears were collected by gynecologist with plastic spatula [4] All cervical smears collected were fixed by 100% methanol and stained by Pap staining method [5]The relevant clinical data were collected by gynecologists, including the exact day of menstrual cycle, age of patients, parity, presenting symptoms etc,history had been elicitedthe smears were reported using the Bethesda system 2001 [6-8] RESULTS In present study, results of 400 Pap smears are analyzed, which had been examined in cytology section (Department of Pathology, PDU Medical College, Rajkot) during 2 years ( ) The commonest complaints observed during study were abnormal vaginal discharge (465%) and menstrual abnormalities (205%) (Table 1) According to classification of smears by Bethesda system, 18 (45%) were unsatisfactory, 148(37%) were normal, 07(125%) had atrophic changes, 190(475%) were inflammatory, 03(075%) were ASCUS, 20(5%) were LSIL, 11(275%) were HSIL and 03(075%) were squamous cell carcinoma The commonest lesion was inflammatory, followed by squamous intraepithelial neoplasia and squamous cell carcinoma (Table 2) Overall incidence of inflammatory lesions was highest in 2 nd decade followed by 3 rd decade E JPharmacol Therapy 16 Out of 190 cases of inflammatory smears, there were 143(36%) cases of acute cervicitis, 39(975%) cases of chronic cervicitis,02(05%) cases of Trichomomas vaginalis, 01(025%) cases of Bacterial vaginosis, 03(075%) cases of Candidiasis and 03(075%) cases of Herpes simplex virus (Table 3) ASCUS incidence was highest in 5 th decadeincidence of LSIL, HSIL and Squamous cell carcinoma were highest after 6 th decade (Table 4) Table 1: Distribution of patients according to symptoms No symptoms Noof patients Percentage (n=400) (%) 1 Discharge Menstrual abnormalities Lower abdominal pain Backache Post coital bleeding Infertility Post menopausal bleeding Other complains Total Table- 2: Distribution of patients according to cytopathological findings No Finding No of Percentage patients (%) (n=400) Inflammatory changes 1 Acute inflammation Chronic inflammation Trichomonas vaginalis Bacterial vaginosis Actinomycetes Candida Herpes simplex virus Total inflammatory smears Epithelial abnormalities 8 ASCUS ASCH Low grade squamous intraepithelial 10 lesions (LSIL) 20 5 High grade squamous 11 intraepithelial lesions(hsil) 12 Squamous cell carcinoma Any glandular lesions Total No of smears showing epithelial abnormalities TOTAL

3 Age group (years) Acute inflammation Dhruva et al Table 3: Age wise distribution of inflammatory smears (Figures in the bracket indicates percentage of the lesions in the respective age group) Chronic inflammation Trichomonas vaginalis Bacterial vaginosis Candida Herpes simplex virus Total < (40) (20) (60) (5257) 11(114) 01 (103) (103) 64 (6597) (4172) 14 (1007) 01 (071) (071) (5321) (2560) 08 (975) (121) 01 (121) 31 (3780) (1428) 03(714) (238) 10 (2380) > (1428) 03 (857) (2225) Total Table 4: Age wise distribution of squamous epithelial cell abnormalities (Figures in the bracket indicates percentage of the lesions in the respected age group) Squamous cell Total Age group (years) ASCUS LSIL HSIL Carcinoma < (103) (103) (215) 02(144) 00 05(359) (121) 08(975) 04(487) 01(121) 14(1707) (476) 03(714) 02(476) 01(238) 08(1904) > (1428) 03(857) 01(285) 09(2571) Table-5: Distribution of epithelial abnormalities according to Parity (Figures in the bracket indicates percentage of the lesions in the respective age group) Parity ASCUS LSIL HSIL Squamous cell Carcinoma Total Nulliparous Para I (338) 02(169) 00 06(508) Para II (138) 07(486) 04(277) 01(069) 14(972) Para III and above (097) 09(873) 05(485) 02(194) 17(1650) Regarding parity, majority patients had 2 children 144(36%) and study showed that high parity was associated with higher occurrence of premalignant and malignant lesions of cervix (Table 5) Regarding the religion of the patients 317(7925%) were Hindus and 83(2075%) were Muslims No any significant difference observed in the incidence of epithelial abnormalities in both religions (Table 6) Regarding locality of the patients majority of the patients 176(44%) were from rural area, 155(3875%) were urban slum and 69(1725%) urban area Incidence of preneoplastic and neoplastic lesions was highest in patients residing in urban slum areas (Table 7) Early age(<18 years) at first sexual intercourse is found to associated with more chances of development of premalignant and malignant lesions of the cervix (Table 8) 17

4 E JPharmacol Therapy Table 6: Distribution of epithelial abnormalities according to Religion (Figures in the bracket indicates percentage of the lesions in the respective age group) Religion ASCUS LSIL HSIL Squamous cell carcinoma Total Hindu (063) 16(504) 08(252) 03(094) 29(914) Muslim 83 01(120) 04(481) 03(361) 00 08(963) Table 7: Distribution of epithelial abnormalities according to locality (Figures in the bracket indicates percentage of the lesions in the respective age group) Locality ASCUS LSIL HSIL Squamous cell Carcinoma Total Urban (144) 02(289) 00 03(434) Urban Slum (129) 09(580) 05(322) 02(129) 18(1161) Rural (056) 10(568) 04(227) 01(056) 16(909) Table 8: Distribution of patients according to age at first sexual intercourse No Age at first sexual intercourse (years) No of Patients (%) 1 <18 117(2925) (6125) 3 >25 38(95) Total 400(100) Incidence of both inflammatory lesions and epithelial abnormalities are higher in HIV positive women as compared to HIV negative woman (Table 9) DISCUSSION AND CONCLUSIONS Pap smear is a simple, cheap, safe and practical diagnostic tool for early detection of cervical cancer in high risk group population and therefore should be established as routine screening procedure Pap smear is a valuable tool for investigation as a screening procedure in asymptomatic women and as a diagnostic procedure in symptomatic women It also has an important role in diagnosis of inflammatory lesions including the identification of causative organism, atrophic changes, changes of radiation therapy and some rare tumors It is recommended that reporting should be done by The Bethesda System as it improves the reproducibility and helps in identification of ASCUS and AGUS lesions and plays a key role to diagnose various intraepithelial lesions and invasive lesions at an early stage and manage them properly High incidences of squamous cell abnormalities are found in patients from urban slum and rural areas, multiparous patients and in patients with younger age at first coitus All suspicious lesions on Pap smears should be followed by repeat Pap smear examination, colposcopy or cervical biopsy Health awareness programs particularly by Media and Government with their implementation in the form of screening camps would be a great help to women particularly in rural and urban slum areas Abbrevations used in text: ASCUS-Atypical squamous cells of undetermined significance ASC-H-Cannot exclude HSILLSIL-Low grade squamous intraepithelial lesion HSIL-High grade squamous intraepithelial lesions SCC- Squamous cell carcinomaagcus-atypical glandular cell of undetermined significance 18

5 Dhruva et al Fig 1: Trichomonas vaginalis (40 ) Fig 3: HPV related changes-perinuclear halo[lsil]( 40 ) Fig2: Candida albicans showing branching hyphae( 40 ) Fig 4: High grade squamous intraepithelial lesion [HSIL] ( 40 ) Fig5: Squamous cell carcinoma(40 ) 19

6 E JPharmacol Therapy Table 9: Cytopathological findings in HIV positive patients No Finding No of patients(n=19) Percentage(%) Inflammatory changes 1 Acute inflammation Chronic inflammation Trichomonas vaginalis Bacterial vaginosis Actinomycetes Candida Herpes simplex virus Epithelial abnormalities 8 ASCUS ASCH Low grade squamous intraepithelial lesions (LSIL) High grade squamous intraepithelial lesions(hsil) Squamous cell carcinoma Any glandular lesions Total No of smears showing epithelial abnormalities 05 Total REFERENCES [1] Papanicolaou, GN: Am J Clin Path, 19: (1940) [2] Papanicolaou, GN and Traut, HF: Am J Obstet Gynecol, 42: (1941) [3] Koss, LG: Acta Cytol, 29(7): (1990) [4]Lucille, M, Marlon, M, Gail, K and Sonia, CA: Wisconsin Med J, 104(06): (2005) [5] Bancroft, JD and Cook, HC: Manual of Histological Techniques and Their Diagnostic Application Churchill Livingstone pub, pp (1994) [6] Solomaon, D: JAMA, 262(7): (1989) [7] Wright, TC, Ferenczy, AF and Kurman, RJ: JAMA, 287(16): (2002) [8] Leopold, GK, Myron, RM: Koss Diagnostic Cytology and its Histopathologic Bases Lippincott Willims and Wilkins pub, 5 th Edi Vol 1, pp (2006) 20