https://doi.org/10.33698/NRF0226-Nainakshi Kashyap, Nadiya Krishnan, Sukhpal Kaur, Sandhya Ghai
Abstract :Background and objective:Cervical cancer is one of the most common malignancies among women. The present study aims to assess the sign and symptoms of cervical cancer in women aged between 25-80 years. Materials and Method: The current study was a case control study. Total age matched 75 cases and controls were taken. The sampling technique for cases was total enumeration technique and for controls purposive sampling was used. Women who satisfied the inclusion criteria were included in study. A questionnaire was developed to identify the sign and symptoms of cervical cancer amongst the subjects. Face to face interview was conducted with the subjects.Result: There was significant difference (p<0.05) of pain during sexual intercourse, bleeding during sexual intercourse, lower back pain, itching and burning in genital area, vaginal discharge that smell unpleasant, bleeding between period, and excessive vaginal bleeding with development of cervical cancer. In logistic regression excessive bleeding and lower back pain showed a significant association with development of carcinoma of cervix. Conclusion: Pain and bleeding during sexual intercourse, lower back pain, itching and burning in genital area, vaginal discharge that smell unpleasant, bleeding between period, and excessive vaginal bleeding were the sign and symptom of cervical cancer. With prior identification of sign and symptoms of cervical cancer can identify carcinoma of cervix in early stages and prompt treatment can be started.
Keywords
Cervical Cancer, Case Control Study
Correspondence at
Dr. Sukhpal Kaur
Lecturer
National Institute of Nursing Education (NINE), PGIMER, Chandigarh
Introduction
Cervical cancer is the one of the common malignancy among women. It is more in developed countries. In India every year 122,844 women are diagnosed with carcinoma of cervix. 67,477 of the women die due to carcinoma of cervix. Women who are older are at more risk of developing carcinoma of cervix. In women carcinoma of cervix is the second most common cancer. The correct cause of cervical cancer is unidentified. So it is necessary to be aware of the epidemiology of cancer of cervix in India.1
In India, among all types of the reproductive tract cancer, cervical cancer accounts for eighty percent of the cases, ovarian cancer is ten percent and uterine body cancer is 4-5%.India has 16% of the World’s cases and just five percent of the cases are reported in early stage of development. Survival rate of cervical cancer is ninety percent if it is localized and if it is metastasized to distant organ then it is 12%. World Health Organization, ICMR and Government of India have given additional stress on early recognition and prevention of cervical cancer. The carcinoma of cervix uteri do not takes place de-novo, but it follows a variety of epithelial cell abnormalities.2
Human body is composed of millions of living cell. Normal cell develop and continuously divide to make new cell and cell dies in an ordered way. Normal cell divides faster as the person grow. During the early years of a person’s life, normal cells divide more rapidly to allow the person to grow. When person becomes an adult, most cells divide only to replace dying cells. Cancer begins when cells in the body have uncontrolled growth. Cancer cells are dissimilar from normal cell. Normal cell dies but the cancer cells continuously proliferate and differentiate to make abnormal cells. In human body most of the cases of cancer cells form a tumor. Cancer cells can also invade other nearby tissues, and metastasizes to distant organ.Uncontrolled growth and invading the other tissues makes a cell cancerous cell.3
The early sign and symptoms of cervical cancer are pain during sexual intercourse ,bleeding during sexual intercourse, bleeding after intercourse, lower back pain, itching and burning in the genital area, vaginal discharge that smell unpleasant, bleeding between periods, excessive vaginal bleeding, sexually transmitted disease, history of genital warts. In early stages, cervical cancer don’t show any symptom and women may complaint of vaginal bleeding, bleeding during sexual intercourse, moderate pain during sexual intercourse, vaginal mass, abnormal vaginal discharge etc4. These symptoms are commonly ignored. In advanced stages of cervix cancer, sign and symptoms include anorexia, loss of weight, fatigue, pain in pelvic area, lower back pain, painful and swollen legs, heavy bleeding from the vagina, leakage of urine or feces from the vagina and bone fractures. Cervical intraepithelial neoplasia is the potential originator of carcinoma of cervix. It is often diagnosed on examination of cervical biopsies or with premalignant dysplastic changes.There is treatment for cervical cancer if it is detected in early stage. The main treatment of cervical cancer includes surgery like (hysterectomy) chemotherapy and radiation therapy. But mostly screening of cervical cancer in the women is not routinely done. The primary goal of screening is to detect precancerous lesions. If it is done properly then we can prevent the progress of cervical cancer.
Objective
- To assess the sign and symptoms of cervical cancer in women aged between 25-80
Material and Method
Research approach is quantitative. Research design is case control study. The cases constitutes the women 25-80 years diagnosed with cervical cancer (for cases) and women not diagnosed with any cancer (for control) attending Gynae OPD, PGIMER, Chandigarh from 16 July to 31 August 2017.Sampling for cases was done by total enumeration technique where as for control it was done by purposive sampling techniques. Total 75 cases as well as 75 controls were enrolled in the study. Criteria opted for matching with cases with respect to age. Written permission was taken from the concerned Department prior to data collection. Ethical clearance of the research protocol was sought from the Institute Ethics Committee of PGIMER, Chandigarh. Interview schedule was used to collect data which comprised of (a)sociodemographic profile of the subjects (b) interview related to sign and symptoms of cervical cancer. Tool was translated into Hindi and again retranslated into English to check translation validity.
All study subjects were informed about objectives and purpose of the study. Informed consent was taken from each subject before collecting data. All the study subjects were informed about confidentiality and privacy about the data collection and informed that this data was used for research purpose only. Face to face interview was done as per interview scheduleina separate room. Total duration of interview was 35-40 minutes for each subject. Data was entered in Microsoft excel spread sheet and SPSS 16.0. Statistical analysis was carried out with SPSS version 16.0. Data was analyzed by using descriptive and analytically i.e., chi square test, Yate’s correction, odds ratio.
Results
Demographic data:
In present study total of 75 cases and 75 controls were taken. Majority of the study subjects were aged between 51-60 (38.8%) yrs. In both the study subjects women were non –working. Majority of the subjects lived in pucca house. In cases as well as control most of the subjects belonged to Hindu religion. Among the 75 cases, 48(64%)were educated. In control 59 (78.8%) women were educated. Majority of the study subjects belonged to rural area. Most of the women diagnosed with cervical cancer were between the age of 51 to 60 yrs. This could be due to that cervical cancer is more prevalent in increasing age.
Probable sign and symptom of Cervical Cancer in case and control
Table I depicts statistically significant percentage of cases were having pain during sexual intercourse, bleeding during sexual intercourse, lower back pain, itching and burning in genital area, vaginal discharge that smell unpleasant, bleeding between period, and excessive vaginal bleeding as compared to controls. These symptoms were present in cases but some of the symptoms were also in control group though they were in low percentage.
Table:-I Probable sign and symptom of cervical cancer in case and control
(N=150)
| Variable | Case n=75(%) | Control n=75(%) | X2, (df), P value |
| Pain during sexual intercourse
No Yes |
56(74.7) 19(25.3) |
73 (97.3) 02 (2.7) |
14.1 (1) 0 .01# |
| Bleeding during sexual intercourse
No Yes |
62 (82.7) 13 (17.3) |
74 (98.7) 01(1.3) |
9.53(1) 0 .01# |
| Bleeding after intercourse
No Yes |
61 (81.3) 14 (18.7) |
74 (98.7) 01(1.3) |
10.6(1) 0 .01# |
| Lower back pain
No Yes |
19 (25.3) 56 (74.7) |
68 (90.7) 07 (9.3) |
65.7(1) 0 .01 |
| Itching and burning in the genital area
No Yes |
23 (30.7) 52 (69.3) |
70 (93.3) 05 (6.7) |
62.5(1) 0 .01 |
| Vaginal discharge that smell unpleasant
No Yes |
13 (17.3) 62 (82.7) |
71(94.7) 04(5.3) |
87.9(1) 0.01# |
| Bleeding between periods
No Yes |
64 (85.3) 11 (14.7) |
74 (98.7) 01(1.3) |
7.33(1) 0.03# |
| Excessive vaginal bleeding
No Yes |
20 (26.7) 55 (73.3) |
73 (97.3) 02 (2.7) |
76.5(1) 0 .01# |
| HIV and AIDS status
No |
75(100) |
75(100) |
|
| Partner is suffering with HIV or AIDS
No Don’t know |
65(86.7) 10(13.3) |
70(93.4) 05(6.7) |
6.67(2) 0 .03 |
# Yate’s correction
Association of sign and symptom of cases and control with cervix cancer
Table II depicts that most of symptoms were much higher in cases as compared to controls. Excessive bleeding had significant associations with cervical cancer. Odds were 62 times higher in cases as compare to controls. There was significant difference among cases and controls with regard to presence of lower back pain. Odds were thirteen times higher in cases who had lower back pain as compare to controls. The odds were three times higher among cases who had itching and burning in genital area as compare to controls. The odds of having bleeding after sexual intercourse was four times higher in cases as compare to controls. Abnormal vaginal discharge was 4.8 time higher in cases as compare to controls. Statistically significant association of cervical cancer was observed in lower back pain and excessive bleeding.
Table II Association of sign and symptom of cases and control with cervix cancer
| Predictor | P value | Odd ratio | 95% confidence interval for odd ratio | ||
| Lower | Upper | ||||
| Pain during sexual intercourse | Yes No | .664 | 1.739 | .143 | 21.08 |
| Bleeding during sexual intercourse | Yes No | 1.000 | <.001 | ||
| Bleeding after sexual intercourse | Yes No | 1.000 | 4.009 | ||
| Lower back pain | Yes | .005 | 12.99 | 2.206 | 76.57 |
| Itching and burning in genital area | Yes No | .226 | 3.004 | .505 | 17.85 |
| Abnormal vaginal discharge | Yes No | .075 | 4.870 | .855 | 27.74 |
| Bleeding in between period | Yes No | .897 | .813 | .035 | 18.71 |
| Excessive bleeding | Yes | <.001 | 61.53 | 8.65 | 435.9 |
No is taken as Reference value (1)
Discussion
Cervical cancer is one of the most common malignancy among the women. It is more common in developing country. It is a leading cause of death among women due to late diagnosis. Early screening for the cervical cancer is most effective measure to stop the progression of the disease. Women should be educated about the early sign and symptoms of cervical cancer to stop the progress of disease and prompt treatment can be started. The present study was sought to achieve the aims to assess the sign and symptoms of cervical cancer among women aged between 25-80 years. The study tried to assess the sign and symptoms of carcinoma of cervix among cases and their matched control.
In present study pain during sexual intercourse, bleeding during and after sexual intercourse, lower back pain, itching and burning in genital area, abnormal vaginal discharge, bleeding between periods and excessive vaginal bleeding had significant association with cervical cancer. Some of the symptoms were also present in control subjects. Abnormal vaginal discharge, lower back pain, itching and burning in genital area were present in controls but they were in low percentage. They were not diagnosed as cervical cancer however; they may be potential for development of cervical cancer. These symptoms can be due to another reproductive infection. So these women were referred to further screening for cervical cancer and other Gynecological disorder.
In present study bleeding between periods and abnormal vaginal discharge was significantly higher among cases of cervical cancer as compare to control group. This data is comparable to study conducted by Mkawa AD et al on symptomatic presentation of cervical cancer. Women who were recently diagnosed with cervical cancer were enrolled in study. Result showed majority of the women had inter menstrual bleeding, post menopausal bleeding and offensive vaginal discharge as a first symptom of cervical cancer.3This could be due to increasing age and more sexual activity leads to injury to the cervix which leads to continuous assault to cervix.
In present study postcoital bleeding had significantly higher among cases of cervical cancer as compare to control group. This data is comparable to study conducted by Shapley Mhigher et al on review of postcoital bleeding and risk of cervical cancer. Result had shown that the point prevalence of postcoital bleeding in the community ranged from 0.7 to 9% among women.4 In present study excessive vaginal bleeding was significantly correlated with cervical cancer. This data is comparable to study conducted by Lotha L et al on Clinicopathological evaluation of abnormal uterine bleeding in perimenopausal women. Result showed that 148 perimenopausal women had uterine bleeding. Majority of the women were age between 40-50 yrs. Uterine bleeding was more in multiparous women (64%). Fibroid uterus and uterine malignancy was the commonest cause of uterine bleeding.5 J Yasmeen conducted a study on screening of Cervical Cancer. Result showed that majority of the women reported backache (44%) and vaginal discharge (41%). These symptoms were suggestive of reproductive tract infection which is also a contributory sign for development of cervical cancer.6 This data is comparable to present study in which 56 (74.4 %) women reported back pain and 62 (82.7%) women reported vaginal discharge. This reproductive infection may be due to poor genital hygiene in the women.In present study itching and burning in genital area is common symptom. This can be due to human papilloma virus which can infect the genital area that leads to itching and burning in genital area.
In present study abnormal vaginal discharge (82.7%), lower back pain (74.4%), excessive vaginal bleeding (73.3%) were the main symptoms of cervical cancer. Odds were high in excessive bleeding, lower back pain, abnormal vaginal discharge, itching and burning in genital area and bleeding after sexual intercourse. Odds were high for having cervical cancer in subjects who had these symptoms. So it is indicated that women who had these sign and symptoms may develop reproductive infection and reproductive malignancy in future it they are not treated at early stage.
Cervical cancer is the common genital malignancy in the women.A major contributory problem is lack of proper utilization of health services, lack of screening for cervical cancer. With prior awareness and identification of sign and symptoms of cervical cancer can reduce the progress of the disease. So there is need to identify the early sign and symptoms of cervical cancer. Proper screening camp should be organized in rural areas and nurses should educate the women regarding early sign and symptoms of the cervical cancer. Easy accessibility of health service to general population should be ensured. By these actions we can reduce the incidence of these illnesses in the society.
References
- National cancer control programme [Internet] [cited 2015 Jul 19]. Ministry of healthand Available from: http://www.mohwf.nic.in/ showfile.php? Lid=324.
- Paul Studies on the Epidemiology of Cervical Cancer. Southern Assam. Assam University Journal of Science &Technology:ISSN 0975-2773 Biological and Environmental Sciences.2011 ;( 7): 36-42.
3 Mwaka AD, Okello ES, Wabinga H, Walter FM. Symptomatic presentation with cervical cancer in Uganda: a qualitative study assessing the pathways to diagnosis in a low-income country. BMC women’s health. 2015 Feb 18;15(1):15.
- Shapley M, Jordan J, Croft A systematic review of postcoital bleeding and risk of cervical cancer. Br J Gen Pract. 2006 Jun 1;56(527):453-60.
- Lotha L, Borah Clinicopathological evaluation of abnormal uterine bleeding in perimenopausal women. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017 Feb 3;5(9):3072-4.
- Yasmeen J, Qurieshi MA, Manzoor NA, Asiya W, Ahmad SZ. Community-based screening of cervical cancer in a low prevalence area of India: A cross sectional study. Asian Pac JCancerPrev[Internet]. 2010;11(1):231-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20593962