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Master Thesis

Cancer du col de l'utérus : retard au diagnostic, impact sur la pratique de médecine générale

Abstract : French Guiana is the French Overseas Department which grows the faster in terms of population and economics. Oncology in the three public regional hospitals was developed in 2010 through framework conventions with Centre Léon Bérard, comprehensive cancer center in Lyon. Cervix cancer is the second cancer in incidence in women in French Guiana. There are only few publications on the epidemiological aspects of this cancer and none on clinical management in French Guiana. Therefore, it was decided to list all the patients who were followed in the three hospitals between January 2010 and December 2017. We were thus able to study the different clinical aspects of this cancer and also the role of health providers in this multicultural environment. This analysis provides evidence of the public health problem faced by the generalist in French Guiana. Patients and methods. We collected the clinical files of all cervix cancer patients seen at the three hospitals in French Guiana through the multidisciplinary consultation meetings. We found 144 cases between 1 January 2010 and 31 December 2017. A standard questionnaire was used to retrospectively analyze patients’ medical files. Staging was performed according to FIGO (Féderation Internationale de Gynécologie-Obstétrique). Patients with localized disease were treated by surgery (conisation; different hysterectomy procedures +/- lymph-node dissection (LND); Patients with locally advanced disease had staging procedure (PET scan + coelioscopic LND) and Radio-chemotherapy +/- brachytherapy; patients with advanced disease had upfront chemotherapy +/- Radio-chemotherapy. Overall survival was established from diagnosis to last follow-up visit or death. Cut-off date was 28/02/2018. Univariate analysis was based on Kaplan Meier estimates and multivariate analysis used a Cox regression model. Results. On 144 patients, the median age at diagnosis was 48 years (extremes 27-91 years) and 60% of them were living on the coast, with easy access to medical care. Forty-five percent of patients were born in French Guiana. Precarity was present in a third of patients. Ten to twenty percent of patients had comorbidities, namely hypertension, diabetes, obesity and cardiovascular diseases. Ten out of 58 patients tested for HIV infection had disease. Pregnancy/Parity was unknown in 28 patients. In the other patients’ median pregnancy and parity numbers were 5 and 4 respectively. Diagnosis was performed: during screening in 46 patients, occurrence of breakthrough bleeding in 64 patients, symptoms related to advanced disease in 13 patients, various gynecological follow up in 7 patients, occurrence of pains in 7 patients, pregnancy in one patient and unknown reason in 6 patients. Median time interval between diagnosis and therapeutic management was 5.4 months (extremes 0- 6 years). Histology was cervix adenocarcinoma in 5 patients, undifferentiated carcinoma and endocrine carcinoma in one patient respectively; all other patients had squamous cell carcinoma. FIGO stage was: localized (Tis – T1a2) in 36 patients; locally advanced (T1b1 – T3a) in 64 patients; advanced (> T3a) in 36 patients; unknown in one patient. In the univariate analysis none of the following variables were significant on overall survival: age, hospital, FIGO stage, place of life, place of birth, time interval from diagnosis to therapeutic management, HIV infection. Nevertheless there were interactions between time interval/precarity, precarity/place of birth and precarity/hospital. In multivariate analysis precarity was found poor prognostic factor (p = 0.036) and time interval, precarity and place of life were factors of an advanced FIGO stage. Conclusion. This study has allowed discussing the major facts on cervix cancer management in French Guiana. It shows the importance of public health problems in this patients’ population: access to caregivers, precarity, and accessibility to heath structures and cultural diversity. General practitioners are key-actors in this setting. Prevention and screening is a key solution to increase outcome of patients with cervix cancer through fast and quality controlled clinical management. GP must be integrated in this health care pathway.
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Master Thesis
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Submitted on : Monday, February 22, 2021 - 2:57:21 PM
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Hemerson Guevara. Cancer du col de l'utérus : retard au diagnostic, impact sur la pratique de médecine générale. Médecine humaine et pathologie. 2018. ⟨dumas-03148775⟩

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