English

Abstract

BACKGROUND: Palliation reduces the severity of disease symptoms, rather than reversing its progression or providing a cure. Metastatic cancer cervix (Ca Cx) is incurable by surgery, radiation or chemotherapy, but these modalities are useful for palliation. Globally about five to six lakh new cases of carcinoma cervix are diagnosed every year. Of these, one lakh cases are diagnosed in India of which 25.0% are from West Bengal only. OBJECTIVES: Our objective was to study the role of palliation in Stage IV Carcinoma Cervix. SETTINGS AND DESIGN: During the study period of five years from January 2007 to December 2011, consecutive seventy five new cases of stage IV carcinoma cervix diagnosed at Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, were included in our study. MATERIALS AND METHODS: Clinical examination with relevant investigations like kidney function tests (KFT), biopsy, cystoscopy, CT scan etc were done for diagnosis & staging. Treatment was decided based on woman's age, general health and the location & type of the tumour. Treatment options were surgery, radiotherapy (RT), chemotherapy (CT) and simple palliation. In our study, combined CT+RT was done in 18.67% patients most of who presented with Stage IV disease. Radiation was given as brachytherapy following teletherapy. Chemotherapy was used as adjunct to RT or for palliation or as neo-adjuvant chemotherapy (NACT), most commonly using paclitaxel (135mg/square metre), cisplatin (50mg/ square metre) and 5fluorouracil (600mg/ square metre). At times, chemotherapy could provide pain relief only. Vault smear and metastatic workup was done during follow-up visits every 8-12 weeks after treatment completion. RESULTS: Majority of patients belonged to the age group 42-69 years with a median age of 53 years. Bladder involvement was seen in 15(20.0%) cases, bowel involvement in 14(19.0%) and distant metastasis in 46(61.0%) cases. Most cases were of Squamous cell carcinoma (94.0%), clinically presenting with foul smelling vaginal discharge ± bleeding per vaginum (100.0%). In our study, significant amount (30.0%) of disease control for a substantial period (1.5 years) was observed. The overall survival rate in patients of Stage IV carcinoma cervix on various forms of palliative treatment was 18.0%. CONCLUSION: Palliation is achieved by surgery, radiation or chemotherapy, though at times, simple palliation is the only feasible option. The poor survival rate was probably due to improper reporting & lack of regular follow up in the given socio-economic background. As cure cannot be achieved in advanced carcinoma cervix, palliation is important in alleviating the distressing symptoms and improving the quality of life.