A Prospective Observational Study on Patterns of Metastases and Clinical Profile of Carcinoma Cervix in Rural Population of Central India: A Tertiary Cancer Center Study

Cervical cancer is the fourth most common cancer among women globally whereas most common cancer among Indian women. According to ICMR data, once in 7 min an Indian woman dies of cervical cancer. The disproportionately high burden of cervical cancer is distributed among the majority of the rural population in developing countries. Previously, FIGO 2009 was used, which was based only on clinical examination; now, FIGO 2018 has been revised due to the importance of para-aortic and pelvic lymph node involvement and clinic-radiological significance. The incorporation of newer FIGO staging systems is quite difficult in Indian rural areas due to the lack of proper infrastructure and also the newer FIGO lacks to give us proper knowledge regarding local disease with direct upstaging without considering parametrial disease. Although there are many studies on the epidemiology and pattern of metastases, most of them involve populations from Western countries. Since demographic factors such as lifestyle, hygiene, vaccination status, early screening measures, pattern of metastases also need to be considered; hence, studying the Indian rural population is necessary. This is a large study in central India involving 1182 patients. The aim of the present study was to determine the demographic pattern, epidemiology, pattern of metastases and clinical profile of patients in the central Indian population. All the patients were also subjected to a survey regarding awareness of the carcinoma cervix and were graded to determine the level of awareness in the rural Indian population.

A prospective study of 1182 patients from January 2020 to December 2022 was performed. Staging was performed according to FIGO 2018 and FIGO 2009, and patients were treated according to their tumor stage and National Comprehensive Cancer Network (NCCN) guidelines.

This study revealed that the most common age groups were 40–50 years [37.2%] and the most common stage IIIB disease [24.2%]; histopathology revealed that the most common site of metastasis was the pelvic lymph node [18.4%]; and the most common site of metastasis was the lung [3.89%]; the least common site of metastasis was the liver [3.1%].

This large central Indian study revealed that approximately 70% of patients presented with late-stage III or IV disease due to lack of proper awareness and only 4% presented in stage I. These findings provide indirect measures of disease burden and a low level of awareness in society. The relationship between parametrial involvement and nodal and distant metastases is established and the special mention of local disease and nodal involvement in staging has also been reported.