Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 37245

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : November | Volume : 5 | Issue : 6 | Page : 1251 - 1255 Full Version

Retrospective Study of Gynaecological Malignancies in Less than 35 Years of Age in Southern India

Published: November 1, 2011 | DOI:
Anagha Kamath, Radha R. Pai

Dr. Anagha Kamath, Assistant Professor, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Mangalore, India.. Dr. Radha R. Pai, Professor & Head of Department, Department of Pathology, Kasturba Medical College, Manipal University, Mangalore, India.

Correspondence Address :
Anagha Kamath, Assistant Professor
Department of Obstetrics and Gynaecology, KMC,
Behind Leo Furnitures, Karangalpady,
Mangalore,India - 575001.
Phone: +91 9880825793


Aim of the Study: To study the incidence, diagnosis and the treatment aspects of genital malignancies in a group of young patients who were less than 35 years old.

Materials and Methods: This study was based on the surgical biopsy materials which were received in the histopathology laboratory of Kasturba Medical College, Manipal University, Mangalore, from 1st January 2006– 31st December 2010. The sources of the specimens were: in-patients biopsy and surgical specimens from the Lady Goshen Hospital and the Kasturba Medical College Hospital, Mangalore. The demographic data which included the age of the patients, the site of the tumour and the diagnosis, were extracted from the request forms and the patients’ case files.

Results: The prevalence of cancer in the younger ages [<35yrs] was 14.2%. The mean age of the presentation was 28 years, (SD+5.12). Ovarian cancer was the most common (70.5%) cancer, followed by cervical cancer (16.3%), choriocarcinoma (7%) and endometrial cancer (2%). There is a rising incidence of cervical and endometrial carcinoma. Advanced stages pre-dominated (58.2%).

Conclusion: Targetting younger women for cancer screening and considering the possibility of malignancy in them is a necessity. This study also provided the basis for the further analysis of the female genital malignancies. The high incidence and the average early mean age of the presentation underlies the importance of the screening programmes and awareness campaigns in our community. Early diagnosis and treatment may help to preserve the fertility and to decrease the mortality. High risk screening could help to reduce the burden of the disease. Education would undoubtly prove to be the most effective challenging remedy.


Genital malignancy, Ovary, Cervix

More than 70,000 new cases of cervical uteri, 3-8% of ovarian and 0.5-4.8% of corpus uteri, 1-3% of vulvar and gestational trophoblastic tumours, and over 75,000 of breast cancers are reported in India every year (1). The predictions of a possibility of an increased incidence of cervical malignancies in the younger women had been raised, way back in 1980 (2). Ten cases of endometrial carcinoma in women who were <25 years were reported 3 decades ago (3). According to the National Center for Health Statistics, cancer is the second leading cause of death in women who are 25-44 years of age. Furthermore, malignancies during pregnancy account for about 5% of all the maternal deaths (4). Despite the relatively high frequency of occurrence of female genital tumours in India, there is still a paucity of awareness on this subject. Therefore, this study was aimed at observing the trend of gynaecological malignancies in the younger age group in our set up.

Material and Methods

This hospital based, retrospective study was based on the surgical biopsy materials which were received in the histopathology laboratory of Kasturba Medical College, Manipal University, Mangalore, from January 1st 2006–December 31st 2010. The sources of the specimens were: in-patients biopsy and surgical specimens from the Lady Goschen Hospital and Kasturba Medical College Hospital, Manipal. The demographic data which included the age of the patients, the site of the tumour and the diagnosis were extracted from the request forms and the patients’ case files. The inclusion criteria were age:15-35yrs, sex:female and diagnosis: primary or secondary genital malignancy [ovary/uterus/cervix/ fallopian tubes/vagina/vulva]. The results were analyzed by using the Chi-square test.


Among 604 cases of histologically confirmed genital cancers which were recorded during the 5 year period of the study with a mean annual total of 120 cases, 84 were in women of the 15–35 years age group . Thus, malignant tumours of the female genital tract in this age group accounted for 14% of all the gynaecological malignancies, with the mean age of presentation being 28 years (SD ± 5.12). In this study, ovarian cancer accounted for a majority (52%) of all the female genital cancers, followed by the cancer of the cervix (39.3%), choriocarcinoma (7%) and endometrial cancer [being the least common one (2%)] (Table/Fig 1),(Table/Fig 2).

(Table/Fig 3) demonstrates the yearly distribution of the gynaecological malignancies within the study period. There was a steep rise in the proportion of younger women from 9% (Jan 2006–Dec 2007) to 18% (Jan 2008–Dec 2010), which plateaued thereafter. (Table/Fig 4) depicts the parity distribution in our study.

A majority of the ovarian carcinomas ( 65%) presented in the age group of 26-35 years. (Table/Fig 2). Surface epithelial tumours were the most common histopathological type, among which the youngest was a 15 yr old case of borderline mucinous tumour. Athough most of the cases (5/7) in the teenage group were germ cell tumours, 2 were borderline epithelial tumours. Cases of granulosa cell tumour (2), Krukenberg tumour following carcinoma of the breast (1) and poorly differentiated Sertoli-Leydig tumours (1)were also seen. Nearly 60% of the ovarian carcinoma cases were diagnosed at an advanced stage. Unilateral oophorectomy was done in 10 patients, among which in 6 patients, the diagnosis of malignancy was incidental and in 4, germ cell tumour was clinically suspected. Debulking was done in 6 patients, in 3 of these, following neoadjuvent chemotherapy. 6 patients in advanced stages were treated with chemotherapy.

The peak incidence of cervical cancer was in the 30-35 years age group, while that of choriocarcinoma was in the 21-25 years age group. Squamous cell carcinoma was the pre-dominant type of cervical carcinoma. The youngest case in our study was a 22 year lady who was diagnosed at stage Ib1 [clear cell adenocarcinoma of cervix]. In all, 13(40%) cases were operable, while 2 patients were retroviral disease positive, with pulmonary tuberculosis. One case was detected coincidently during the medical termination of pregnancy. Wertheim’s hysterectomy was done in 12 patients and 1 patient was discharged against medical advice. Neoadjuvant chemotherapy was given in 5 patients, out of which one developed a burst abdomen.

The youngest age of presentation of choriocarcinoma was a 19 yr old unmarried girl who presented with septicaemia. On emergency laparotomy, wide spread metastatic lesions were found to be present, her tissue biopsy revealed stage IV choriocarcinoma and the patient ended up with mortality. Three cases (50%) were preceded by molar pregnancies, 2 (33%) by term gestation and 1(17%) by abortion(Table/Fig 5)(Table/Fig 6)(Table/Fig 7)(Table/Fig 8).

Endometrial carcinoma constituted 2% of the genital cancers (adenocarcinoma type). Both these patients had a history of infertility and were of the 30-35 year age group, with intractable menorrhagia.


The cancer which occurs between the ages of 15 and 30 years is 2.7 times more common than the cancer which occurs during the first 15 years of life, but it is much less common than the cancer in the older age groups, and it accounts for just 2% of all the invasive cancers (5). It is noteworthy that cancer in the 15-29 years age group as a proportion of cancer at all ages is five times higher in India than England despite the actual incidence being lower in India (6). This possibly reflects that a higher percentage (35%) of the women in India are in the age group of 15-35 years in the population pyramid (7).

The frequency distribution of the cancer types changes dramatically from the ages of 15-30 years, in such a way that the pattern at the youngest age does not resemble the one at the oldest age (5). Malignant tumours of the female genital tract in the younger age group accounted for 14% of all the female cancers, while cancers of the ovary accounted for a majority of the cancers (52%), followed by cervical cancer (16.3%), choriocarcinoma (7%) and uterine carcinomas (2%). Although breast cancer is the most common tumour which affects women world wide, the cancer of the uterine cervix is still the most common one in the developing countries (8). However, in the present study, although the prevalence of ovarian malignancy predominated the prevalence of all the female cancers, the prevalence of cervical cancer was very much comparable to that of ovarian carcinoma.

About 94% of the ovarian tumours are said to arise from the surface epithelium of the ovary (9). Similarly, in this study, 70.5% of the ovarian tumours were of epithelial origin. The events which lead to malignant transformation within these cells are uncertain, but the risk factors that appear to be related to the development of the ovarian cancers include genetic, environmental and hormonal factors (10). The vast majority of cases of cancer which are diagnosed before the age of 30, appear to be spontaneous and unrelated to either the carcinogens in the environment or familycancer syndromes. There are exceptions, but the exceptions are rare (5). Therefore, the need to examine the ovaries as much as the need to visualise the cervix at every opportunity like the USG of the abdomen, sterlisation surgeries and caesarean sections is emphasized.

Fertility preserving conservative surgeries warrant an even greater importance in this age group. In the young women with stage Ia disease who are desirous of further childbearing, unilateral salpingo-oophorectomy may be associated with a minimal increased risk of recurrence, provided a careful staging procedure is performed and due consideration is given to the grade and the apparent self containment of the neoplasm (11).

The prevalence of the Krukenberg’s tumours varies from 1% (incidental adnexal surgery) to 13% (surgery for pelvic masses) and up to 25% (autopsies or therapeutic oophorectomy) (12). Bigorie V et al (13) and Ayhanet et al (14) reported respectively, 29 patients who were aged >16 years and 35 patients who were aged >22 years.

Within the UK, cervical cancer was the most common cancer in women who are less than 35 years of age ,with 702 cases being diagnosed in 2007 (15). Between 2004–2008, the US incidence of cervical cancer in girls under the age of 20 was reported to be 0.1%, rising to 14.3% in women who were aged 20 to 24 years, of the total burden (16). The probability of developing cervical cancer by age is: 1 in 638 for women who were aged 39 years and younger (17).

More than 70% of the women with cervical carcinoma were of the 30-35yrs age group, thus depicting the need for a prompt screening implementation in all the younger women. The high incidence frequency of carcinoma of the cervix could be attributed to early marriage and the high parity in our region. Epidemiological studies have consistently indicated that the risk of the cancer of the uterine cervix is strongly influenced by measures of sexual activity (18). In India, HPV 16, 18, 31, 33 and 45 account for >92% of the squamous cell carcinomas and 95% of the cervical adenocarcinomas (19). The well-known risk factors include a high number of live births, the long-term use (12 years or more) of oral contraceptives, tobacco smoking, lack of food which contains betacarotene, vitamins A, C and E and selenium (20),(21). The risk of cervical intraepithelial neoplasms (CINs) in HIV sero-positive women is at least 5 fold higher than in their sero-negative counterparts (18). Implementing screening programmes has seen a major drawback in India as a result of illiteracy, the vast population and the lack of facilities at the peripheries.

Neoadjuvent chemotheraphy, followed by radical surgery, has proved to be valid alternative with a 48 % to 100% operability rate, with no influence on the surgery related morbidity. A pathologically confirmed compete response was detected in 9-18 % of the cases, the incidence of the lymph node metastasis being much lower than expected for the same stage and tumour size (22). The complications of this combined modality include short term complications like (within 30 days from the end of the treatment) accidental injuries to the vessels, requirement of additional blood transfusion(s) (5%), bladder dysfunction (17%), lymphocysts (18%), abdominal wound dehiscence (2%) and ureteral stenosis/fistulas (1%). The long-term, severe complications are dyspareunia(10%), chronic neurologic bladder (7%) and vesico-ureteral, or rectovaginal fistulas (3%) (23). The tolerance of the combination therapy would probably depend on the age, diet and the body mass index.

A majority of the women in this study were averagely built and belonged to a low socio-economic strata.

Unlike other studies, in the present study, there was no significant difference in the parity of the ovarian carcinoma which was different from the usual prevalence, while the endometrial carcinomas were diagnosed in the nulligravida, but the maximum number of the patients with carcinoma of the cervix were multiparous. Contraception is protective against a majority of the genital tumours (24). Unfortunately, the knowledge, awareness and the practice of this beneficial aspect is very low. Sterilisation was the only reported mode of contraception in our study.

Choriocarcinoma was found to be the second most common malignant tumour of the female genital tract in the African studies (25), but in this study, it accounted for only 7% of the tumours of the female genital tract. Considering that choriocarcinoma can complicate any conception and that its presentation may mislead clinicians, it is possible that the true frequency of this entity is very high than that which was suggested by this study. Throughout the world, the incidence rates for choriocarcinoma differ widely (26). For example, in Europe and North America, choriocarcinomas are reported to affect one in every 30,000-40,000 pregnancies, and one in 40 molar pregnancies (27), whereas in Southeast Asia, rates as high as one in every 500-3000 pregnancies have been reported (28). Although choriocarcinoma can be preceded by any gestational event, hydatidiform mole was found to be its most common precursor. The factors which were found to be associated with gestational trophoblastic neoplasia included professional occupation, a history of prior spontaneous abortions and the mean number of months from the last pregnancy to the index pregnancy (29). Although persistent gestational trophoblastic disease has an excellent prognosis, non-compliance with the follow-up can lead to a delay in the diagnosis, and an inconsistent compliance with the treatment can lead to the development of chemotherapy-resistant disease. Factors such as access to contraception or timely health care, as well as genetic, dietary and other environmental influences, warrant further investigation (30).

The follow up was lost in our population, mainly due to ignorance and a poor socio-economic status. The regulations for the medical termination of pregnancy (MTP) may have been abused under the pretext of fertility regulation. Moreover, because of the lack of the MTP products for histopatholgical examination , the molar pregnancies could go undiagnosed. Inspite of the availability of standard investigative modalities in our government tertiary care centers at fairly reasonable rates, the below poverty line proportion hinders the efficiency today.

Radical management always triumphs over other reasonings due to a poor follow up. Criteria and issues such as risk adapted therapies to preserve the fertility, to reduce the adverse effects on the physical appearance and to avoid a surgical menopause, thereby receive negligible consideration in our centers unlike in the developed countries .

This data may not represent the accurate community prevalence rates . In India, the actual cancer statistics may be much more than that which is present in the hospital based data.

Management in the young is a real dilemma with tolerance and efficiency on one side and the problem of feminity, fertility, teratogenicity and the combination therapy of radiotherapy/neoadjuvant chemotherapy on the other side. The training modules should include a concern towards conservative surgeries like trachelectomy/cystectomy and also an approach to deal with cancer which complicates pregnancies. These findings could have a significant implication on the health planning and the clinical practice in our country. Furthermore, the emergence of new diseases such as the Acquired Immune Deficiency Syndrome may conceivably alter the pattern of the female genital malignancies (25).


Targeting younger women for cancer screening and considering the possibility of malignancy in them is a necessity. The need to examine the ovaries, as much as the need to visualise the cervix at every opportunity like USG of the abdomen and during procedures like laparoscopy, sterlisation and caesarean sections is emphasised. Endometrial evaluation is a must in patients with menorrhagia/ infertility/polycystic ovarian syndrome at all levels of health care. An early diagnosis and treatment may help to preserve the fertility and to decrease the mortality. A high risk screening could help in reducing the burden of malignancy. Education would undoubtly prove to be the most effective challenging remedy. This study is a basis for the further analysis of the female genital malignancies in the young in India.


Devi KU. Current status of the gynaecological cancer care in India. J Gynecol Oncol 2009; 20:77–80.
Beral V, Booth M. Predictions of cervical cancer incidence and mortality in England and Wales. Lancet 1986; 327:479- 95.
Farhi DC, Nosanchuk J, Silverberg SG. Endometrial adenocarcinoma in women who are under 25 years of age. Obstet Gynecol 1986;68: 741-5.
Rayburn WF .Foreword . Cancer Complicating Pregnancy .In, Leslie KK. Obstet Gynaecol Clin N Am. Philadelphia: Saunders 2005;13-4.
Bleyer A, Vinyl A, Barr R, Introduction. In: Bleyer WA, O’Leary M, Barr R, Ries LAG (eds). Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER Incidence and Survival: 1975-2000. National Cancer Institute, NIH Pub. No. 06– 5767,2006;1-4.
Arora RS, Alston RD, Eden TO, Moran A, Geraci M, O’Hara C et al. Cancer At Ages 15-29 Years ; The Contrasting Incidence In India And England. Pediatr Blood Cancer 2010 Oct 14 [Epub ahead of print].
Park K. Demography and family planning. In: K. Park . Parks textbook of preventive and social medicine , 20th edition. Jabalpur, Banaridas Bhanot Publishers, 2009; 411.
Olukoye AA. Cancers of the breast and cervix in Nigerian women and the role of primary health care. Nig Med Practitioner 1989;18:26-30.
Monaghan JM. Malignant Disease of the Ovary. In: Edmonds DK . Dewhurst’s Textbook of Obstetrics and Gynaecology for Postgraduate, 6th edition;Oxford: Blackwell Science Ltd, 1999;593.
Nugent D, Salha O, Balen AH, Rutherford AJ .Ovarian neoplasia and subfertility treatments. Br J Obstet Gynaecol 1998;105:584-91.
DiSaia PJ. The adnexal mass and early ovarian cancer . In , DiSaia and Creasman, Clinical gynaecologic oncology: 7th edition. Philadelphia, Elseviers, 2007;302-6.
Garg R, Zahurak ML, Trimble EL, Armstrong DK, Bristow RE. Abdominal carcinomatosis in women with a history of breast cancer. Gynecol Oncol 2005;99:65-70.
Bigorie V, Morice P, Duvillard P, Antoine M, Cortez A, Flejou JF et al Ovarian metastasis from breast cancer: report of 29 cases. Cancer 2010;116:799-04
Ayhan A, Guvenal T, Salman MC, Ozyuncu O, Sakinci M,Basaran M et al. The role of cytoreductive surgery in non-genital cancers which were metastatic to the ovaries. Gynecol Oncol. 2005;98:235-41.
Cervical cancer-UK incidence statistics. Cancer research UK 2006.
Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W et als (eds). SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, Available from URL: http://seer.,
American Cancer Society-Cancer Facts &Figures2008.At:http://www. (Accessed May 21, 2008).
Spitzer M. Lower genital tract intraepithelial neoplasia in HIV infected women: Guidelines for evaluation and management. Obstet Gynecol Surv 1999 ;54:131-7.
Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D et al. Efficacy of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infections and pre-cancer which are caused by the oncogenic HPV types (PATRICIA): final analysis of a doubleblind, randomised study in young women. Lancet 2009;25:301-14.
Kjellberg L, Hallmans G, Åhren AM, Johansson R, Bergman F, Wadell G et al . Smoking, diet, pregnancy and oral contraceptive use as the risk factors for cervical intra-epithelial neoplasia with respect to the human papillomavirus infection. Br J Cancer 2000;82:1332–8.
Labani L, Andallu B, Meera M, Asthana S, Satyanarayana L. The food consumption pattern in the cervical carcinoma patients and the controls. Indian J Med Paediatr Oncol 2009;30:71-5.
Benedetti-Panici P, Greggi S, Scambia G, Amoroso M, Salerno MG, Maneschi F, et al. Long-term survival following neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer. Eur J Cancer 1998;34:341 -6.
Benedetti-Panici P, Greggi S, Colombo A, Amoroso M, Smaniotto D, Giannarelli D, Amunni G, et al. Neo-adjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study. J Clin Oncol 2002;20:179-88.
Centers for Disease Control Oral contraceptive use and the risk of ovarian cancer. JAMA 1983 ; 249 :1596–9.
Kyari O, Nggada H, Mairiga A. Malignant tumours of female genital tract in north eastern Nigeria. East Afr Med J 2004;81:142-5.
Brinton LA, Bracken MB, Connelly RR. The incidence of choriocarcinoma in the United States. Am J Epidemio 1986;123:1094-100.
Shanmugaratnam K, Muir CS, Tow SH, Cheng WC, Christine B, Pedersen E, et al. Rates per 100,000 births and the incidences of choriocarcinoma and malignant mole in the Singapore Chinese and the Malays: Comparison with Connecticut, Norway, and Sweden. Int J Cancer 1971;8:165-75.
Berkowitz RS, Cramer DW, Bernstein MR, Cassells S, Driscoll SG, Goldstein DP et al . Risk factors for complete molar pregnancy from a case-control study. Am. J. Obstet. Gynecol 1985; 152:1016–20.
Kohorn EI . The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: Description and critical assessment. Int J Gynecol Cancer 2001;11:73-7.
Smith HO, Qualls CR, Prairie BA, Padilla LA, Rayburn WF, Key CR, et al . Trends in gestational choriocarcinoma: A 27-year perspective. Obstet Gynecol 2003;102: 978-87.

DOI and Others


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)