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SYMPTOMATOLOGY OF GYNAECOLOGICAL MALIGNANCIES: AN EXPERIENCE AT THE
GYNAECOLOGY DEPARTMENT, BENAZIR BHUTTO HOSPITAL, RAWALPINDI, PAKISTAN
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Samra Ayub, Ayesha Basharat, Asma Tanvir Usmani
Benazir Bhutto Hospital, Rawalpindi, Pakistan
RESULTS
INTRODUCTION
Symptoms suggestive
of malignancy
Text…
Gynaecological cancers are a group of different malignancies
of the female reproductive system, which include cancers of
the ovary, cervix, body of the uterus, vulva and vagina1,2.
Gynaecological malignancies continue to be a major cause of
morbidity as well as mortality in women worldwide3.
Unfortunately, some cancers seem to be on the increase. Over
the years, irrespective of social class, the number of
gynaecological cancers is increasing, with more cases at the
younger age4. Worldwide, cancer incidence rates vary widely
between different geographic regions and ethnic groups. In
Pakistan, despite the network of registries over the length and
breadth of the country, a realistic estimate of the
gynaecological cancers is lacking due to the non-availability of
adequate data, poor recording systems, poor referral practices,
lack of cancer awareness, poor health education and inaccurate
death certification. Cancer statistics from different parts of
Pakistan reveal that majority of cancer cases present in an
advanced stage, which reduces their chances of survival even
after treatment. Therefore, prevention, early detection and
treatment seeking pattern for cancer, needs more attention. The
knowledge and skills in the above areas need to be enhanced.
Having the highest fatality-to-case ratio of all the
gynaecological malignancies, ovarian cancer is of public health
importance5,6. However, endometrial carcinoma and vulval/
vaginal carcinoma are usually the malignancy of elderly
women, thereby raising the mortality significantly. It has been
reported in earlier literature that in the developing countries,
poor knowledge about these cancers and health care seeking
behavior of the patients add to this burden significantly7.
Methods for optimal screening of gynaecological cancers are
still being investigated. Cervical cancer is the only
gynaecological malignancy for which a screening modality is
widely accepted and recommended to all women8. However,
being a laboratory-based test, Pap smear requires appropriate
infrastructure and skilled manpower. This is a cost intensive
procedure too.
This study reflects the importance of awareness among women
as well as the health care personnel about the possible
symptoms of gynaecological malignancies and highlights the
need for addressing and prioritizing resources towards
educating women and the broader community about these
malignancies, especially the symptoms.
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Gynaecological malignancies presented with postmenopausal
bleeding in 37 (60.6%) ; abdominal distention or discomfort in
29 (47.5%) ; irregular, heavy or prologed vaginal bleeding in
19 (31%); excessive , offensive with or without blood stained
vaginal discharge in 18 (29.5%) ; followed by lump in
abdomen in 9 (14.7%) and contact bleeding in 5 (8.1%)
patients. Twenty-nine patients (25.7%) reported miscellaneous
symptoms including loss of weight; respiratory distress; gastrointestinal symptoms like dyspepsia, loss of appetite with a
sense of bloating after meals, diarrhea; urinary symptoms like
frequency of micturition, pain in urination, difficulty in
urination, hematuria, true incontinence of urine.
Histopathological
confirmation
Site specification
MATERIALS AND METHODS
Study Design:
Crosssectional
observational
study
Setting:
Obstetrics &
Gynaecology
department,
Benazir
Bhutto
Hospital,
Rawalpindi
Study
Duration: Jun
2008 till Aug
2011
CONCLUSIONS
Sample Size:
61 patients
diagnosed and
referred to
NORI
REFERENCES
Presenting
Symptoms
In the Obstetrics & Gynaecology department of Benazir Bhutto
Hospital, Rawalpindi, records of patients with histopathologically
confirmed gynaecological malignancies were reviewed to document
their presenting symptoms.
RESULTS
OBJECTIVES
1. To identify the symptoms suggestive of gynaecological
malignancies followed by histopathological confirmation of the
diagnosis.
2. To determine the proportion of the histopathologically
confirmed cases specific to sites.
• Patients can be identified as possible cases of gynaecological
malignancies according to some suggestive symptoms, especially
when regular screening procedures cannot be implemented in
practice.
•Need to increase awareness about the gynaecological malignancies
among women and the community.
•Health care personnel have a major role to identify the warning
symptoms early for further investigation of the possible cases of
gynaecological malignancies.
A total of 61 patients were diagnosed as having gynaecological
malignancy and were referred to NORI from June 2008 to August
2011. The age of the patients ranged from 13 to 80 years with a
mean age of 49.6 ± 17.5 years.
Mean age ± SD (Years)
Range (Years)
Postmenopaus
al bleeding
( n = 37)
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Endometrium
( n = 16)
13
12
19
3
Heavy or
prolonged
vaginal
bleeding
( n = 19)
7
8
9
15
7
Excessive,
offensive with
or without
blood stained
vaginal
discharge
( n = 18)
49.6 ± 17.5
Contact
bleeding
( n = 5)
13-80
Vulval
Growth
(n=5)
Miscellaneous
( n = 29 )
TEMPLATE DESIGN © 2008
Cervix
(n= 17)
Abdominal
distention or
discomfort
( n = 29)
Lump in
abdomen
( n = 9)
AGE
Ovary
(n=22)
3
Vulva ( n = 5)
1
2
4
1
5
13
Vagina
( n = 1)
5
11
1
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4. Content
Chhabragoes
S, Sonak
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