Cervical cancer is the leading cause of cancer death among women in Uganda. Given the high prevalence of genital human papillomavirus infection, the current unavailability of radiotherapy, and the absence of a national cervical cancer prevention and control program, these deaths will likely increase. Efforts to organize an effective cervical cancer screening and treatment program will require adequate financial resources, the development of infrastructure, training needed manpower, and surveillance mechanisms of the targeted women. Screening with VIA (visual inspection with acetic acid) and HPV DNA testing on self-collected samples with processing at a specific site could, for the first time, make national, large-scale population-based screening feasible in Uganda. Combining screening efforts with timely treatment of all screen positives for HPV infection can prevent progression to invasive cervical cancer. To date, this is the most effective intervention in closing the current prevention gap.Training of health professionals, ongoing construction of new radiotherapy bunkers, and opening of regional centers are all geared towards improving cervical cancer care in Uganda. The Uganda Cancer Institute Bill establishes the Institute as a semi-autonomous agency mandated to undertake and coordinate the prevention and treatment of cancer. Its implementation will be a milestone in cervical cancer prevention and control. However, execution will require political will and an increase in domestic and international investment.
PET/MRI is feasible and has at least comparable diagnostic ability to PET/CT for identification of primary cervical and endometrial tumors and regional metastases. PET/MRI may be superior to PET/CT for initial radiographic assessment of cervical cancers.
Background. Uterine fibroids are common benign tumors in women. Clinical manifestations are well known. Acute complications necessitating emergent surgical intervention are rare. Case. We report a case of a 53-year-old woman with a history of uterine fibroids presenting with acute-onset severe abdominal pain. Imaging indicated massive free fluid and a large partially solid uterine mass. Vitals were consistent with hypovolemic shock. Examination revealed a surgical abdomen. She underwent an emergent laparotomy and total hysterectomy. Surgery revealed 4.5 L of hemoperitoneum and a 15 cm degenerated uterine fibroid with active bleeding. Pathology was consistent with intraoperative findings. She required transfusion of numerous blood products perioperatively. Her postoperative course was uncomplicated. Conclusion. It is rare for a uterine fibroid to spontaneously rupture. However, prompt recognition of this severe complication is critical for expeditious, life-saving surgical management.
Over 90% of people living in low- and middle-income countries (LMICs) do not have access to surgical care. In the absence of appropriate surgical care, there is high morbidity and mortality from surgically curable diseases, such as cervical cancer. Laparoscopic surgery for gynecologic cancer in LMICs is extremely limited. The benefits of laparoscopy over open surgery are even more pronounced in LMICs than in resource-rich countries. Barriers to implementation of laparoscopic surgery in LMICs should be identified and addressed in order to improve global cancer care and the lives of women worldwide.
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