Optimization of inpatient treatment of cervical cancer in the Republic of Tajikistan

Background. In the structure of cancer incidence, the share of cervical cancer (CC) in Tajikistan is 8.12 % and is in 2^nd place after breast cancer.

Aim. Optimization of inpatient treatment for the invasive form of CC in the Republic of Tajikistan in order to improve 5-year survival results by complying with the adopted new clinical guidelines.

Materials and methods. The clinical material is based on a study of the medical history of 100 patients with CC, and was also assessed in accordance with the requirements of the new clinical guidelines for the treatment of CC, adopted at the Republican Oncological Research Center.

Results. In Tajikistan, the morbidity and mortality of patients with CC have remained high over the past 11 years, accounting for 8–9 % of the overall structure of cancer incidence. The coverage of visual screening in the republic does not exceed 30 % and is limited to the urban population. Therefore, the proportion of patients diagnosed at stages III–IV of the disease for the period from 2014 to 2024 ranged from 18 to 34 %, and the 5-year survival rate ranged from 15 to 23 %. The peak incidence is at stage IIb, which accounts for 56 % of patients. The distribution of women by stage shows that in fact 82 % of women have a degree from locally advanced to widespread process (IIa–IVb), 6 % of women have stage Ia1–Ia2 with a favorable prognosis, and 12 % of women have stage Ib1–IIa1 with a relatively favorable prognosis. Tumors with a high degree of differentiation G₁ were found in 14 %, G₂ – in 71 %, G₃ – in 15 % of cases. Based on the new clinical guidelines, the main treatment options are surgery, radiation therapy, chemotherapy, and combination approaches.

Conclusion. In general, in the republic there is a commitment to the use of treatment regimens for CC, in accordance with the adopted new clinical protocol. The coverage of visual screening in the republic is not sufficient; therefore the majority of patients at the invasive stage of cervical cancer are identified by self-referral. This explains the late presentation of patients and the high proportion of patients who are diagnosed at stages II–IV of the disease. As a consequence, the 5-year survival rate remains low, which requires improvement in the quality of hospital care. In addition, correct staging using modern radiodiagnosis and histology, aimed at determining the status of the lymphatic pathways of the parametrium, pelvis and para-aortic tissue and distant metastases, is critical for the selection of effective treatment.