The role of punch biopsy in the management of carcinoma of the cervix in a low resource centre

Background: Carcinoma of the cervix is the commonest malignant tumor of the female genital tract in Northern Nigeria and the leading cause of cancerrelated death in women in developing countries. The predicament is further worsened by poor uptake of cytological screening programs, which are either not available or where available are underutilized due to lack of widespread awareness and the cost as an average Nigerian earns less than a dollar per day. In addition to the above constrains, majority of these patients also presents late to the hospital for intervention. Objective: To emphasize the significance of punch biopsy and clinical staging of advanced carcinoma of the cervix and see how we can shift from our traditional, Examination under Anesthesia (EUA) to Clinical staging and punch biopsy for advanced carcinoma of the cervix. Methodology: Review of existing literature and experience from our own center. Results: The punch biopsy has 88.8% positive predictive value in making a diagnosis of cancer of the cervix. Late presentation was as high as 81.7 percent for carcinoma of the cervix in our centre. The patients present late for care; majority actually presents in stages III & IV when little or nothing can be done for them. Conclusion: In view of these predicaments that face a gynecological oncologist practicing in low resources settings like ours, there is a need to consider the role of punch biopsy, clinical staging and radiological assessment for making a diagnosis, especially among those women who cannot afford EUA or are having renal complication that makes EUA unachievable.