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British Journal of Healthcare and Medical Research - Vol. 12, No. 02
Publication Date: April 25, 2025
DOI:10.14738/bjhmr.1202.18298.
Hatim, G., Chekrine, T., Alla, M. A., Bahri, O., Belhouari, M., Bourhafour, M., Bouchbika, Z., Benchakroun, N., Jouhadi, H., Tawfiq, N.,
& Sahraoui, S. (2025). Cervical Cancer: Epidemiological, Clinical and Therapeutic Aspects Experience of the Mohamed VI Center for
Cancer Treatment. British Journal of Healthcare and Medical Research, Vol - 12(02). 40-52.
Services for Science and Education – United Kingdom
Cervical Cancer: Epidemiological, Clinical and Therapeutic
Aspects Experience of the Mohamed VI Center for Cancer
Treatment
ABSTRACT
Introduction: Cervical cancer is the second most common gynaecological
cancer after breast cancer in low-middle income countries, particularly
Morocco. Worldwide, cervical cancer is the 4th most frequently diagnosed
cancer and the 4th leading cause of cancer-related death in women. Its
pathogenesis is linked to HPV infection. Improved hygiene and living
conditions, and the organization of FCV screening, could reduce the
incidence and mortality of this neoplasm. HPV vaccination and screening
remain the two mainstays of cervical cancer prevention.
Aim of the study: The aim of our work is to study the epidemiological,
clinical, paraclinical, therapeutic and evolutionary profile of cervical
cancer at the Mohamed VI Center for Cancer Treatment.
Material and methods: This is a descriptive retrospective study, spread
over a six-year period from December 31, 2016 to, January 1, 2010,
including all patients diagnosed with cervical cancer and initially managed
at the Mohamed VI Center for Cancer Treatment.
Results: A total of 168 cases meeting the inclusion criteria were collected.
The age group most affected was between 51 and 60. The age of onset of
sexual activity was before 18 in 23.8% of cases. Multiparity was noted in
73.82% of cases. 48.8% of patients were using oral contraception.
Repeated genital infections were found in 41.07% of patients, the majority
of whom were inadequately treated and monitored. Genital bleeding was
the main reason for consultation in 89.25% of cases. The mean tumor size
was 5 cm, with extremes of 2 and 10 cm. Squamous cell carcinoma
predominated with a percentage of 87.5%. Patients were classified
according to F.I.G.O 2009 criteria, and stage IIB was most frequently found,
with a percentage of 64.2% (108 patients). The most commonly used
protocol was concomitant radio- chemotherapy (CRT) followed by
brachytherapy in 51.2% of patients. Outcome was specified for 112
patients. It showed locoregional recurrence in 16 patients, lymph node
metastases in 2 patients, 1 case of bone metastasis and 1 case of liver
metastasis. In our study, estimates of overall survival, progression-free
survival and relapse-free survival at 5 years were 71%, 63.2% and 78%
respectively. Survival by F.I.G.O. stage was 86%, 78%, 56% and 9%
respectively for stages I, II, III and IV.
Conclusion: Cervical cancer remains a major public health problem,
especially in low and middle income countries where it is a major cause of
death. Major advances in diagnosis and treatment occurred in the
management of cervical cancer but we still need to step up our screening
efforts and extend them to the entire population in order to make
impacting breakthroughs.
G. Hatim*
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
(e-mail : h.ghita23@gmail.com)
T. Chekrine
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
M. Ait Alla
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
O. Bahri
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
M.Belhouari
Clinical Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
M.Bourhafour
Clinical Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
Z. Bouchbika
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
N. Benchakroun
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
H. Jouhadi
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
N. Tawfiq
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca,
Morocco
S. Sahraoui
Radiation Oncology Department, IBN Rochd
University Hospital Center, Casablanca
Morocco
*Corresponding Author
INTRODUCTION
Cervical cancer, although on the decline in most developed countries in recent years, ranks
4th in terms of frequency and cause of death from cancer in women worldwide, with around
604,000 new cases and 342,000 deaths in 2020(1). In emerging countries, notably Morocco,
cervical cancer remains a major public health problem. It is the 2nd most common cancer in
women after breast cancer (1). It is currently well established that the human papillomavirus
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Hatim, G., Chekrine, T., Alla, M. A., Bahri, O., Belhouari, M., Bourhafour, M., Bouchbika, Z., Benchakroun, N., Jouhadi, H., Tawfiq, N., & Sahraoui, S.
(2025). Cervical Cancer: Epidemiological, Clinical and Therapeutic Aspects Experience of the Mohamed VI Center for Cancer Treatment. British
Journal of Healthcare and Medical Research, Vol - 12(02). 40-52.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18298.
(HPV) is the main pathogenic agent of cervical cancer. Other sexual and non-sexual factors act
as cofactors in the progression of HPV infection to cervical cancer (2). Cervical cancer starts
by a pre-cancerous phase that can last several years before clinical symptoms appear, making
it an important area for prevention through testing, and thus a preventable disease. Regular
testing with cervico-vaginal smears enables precancerous lesions to be detected and treated
at an early stage. In industrialized countries, advances in diagnosis and treatment, coupled
with the introduction of an appropriate policy of systematic screening, have led to a sharp
reduction in mortality and morbidity, with only 15% of cervical cancers occurring, and a
decline of 4% per year (3). HPV vaccination is complementary and synergistic with testing,
making it a standard for primary prevention of this cancer. Indeed, vaccines could be the most
effective weapons against the spread of this disease in developing countries. The therapeutic
challenge of the last ten years has been to reduce mortality and improve patients' quality of
life.
The aim of our study is not only to discuss the epidemiological, clinical and
anatomopathological profile of cervical cancers in our series, but also to identify the different
therapeutic modalities instituted. These results will then be compared with those published
in the litterature.
MATERIEL AND METHODS
Our study is a retrospective descriptive analysis of 168 patients with cervical cancer treated
at the Mohamed VI Center for Cancer Treatment, over a total period of 06 years from
December 31, 2016 to January 1, 2010. All patients diagnosed with cervical cancer and
initially treated at the Mohamed VI Center for Cancer Treatment were included in our study,
whether or not they underwent medical or surgical treatment. We extracted the necessary
information from the electronic patient file of the "ENOVA" information system, which enabled
us to retrace the history of consultations, hospital admissions, various paraclinical
explorations and therapeutic management. Statistical analysis of our study was performed
using SPSS version 22.0 (Statistical Package for the Social Sciences). The method used to
calculate survival was Kaplan-Mayer.
RESULTS
Epidemiological Profile
Age was specified in all our patients (168 cases). The extreme ages ranged from 31 to 81, with
an average of 56. The age group most affected was between 51 and 60 years old,
corresponding to 38% of cases (Table 1). 77% of patients were from urban areas and 23%
from rural areas. The proportion of our sample who had early sexual relations before the age
of 18 was 23.80%. This notion was specified with reference to the age of 1st marriage.
Concerning the multiplicity of sexual partners, in our Moroccan context, this notion
corresponded to the number of marriages, although marital status alone is not sufficient to
determine sexual activity. It was found in 3 patients, representing 1.8% of cases, with 2
patients married on 2 occasions and one patient on 3 occasions.
Table 1: Summary of patients Characteristics
Patient’s characteristics N (%)
Total patients 168
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British Journal of Healthcare and Medical Research (BJHMR) Vol 12, Issue 02, April-2025
Services for Science and Education – United Kingdom
Age (years)
Range
Most affected
31 – 81
51 – 60
Parity
None
≤ 3 parity
≥ 4 parity
11 (6.54%)
33 (19.64%)
124
(73.82%)
Repeated genital infections
Yes
No
69 (41.07%)
46 (27.38%)
Symptoms
Spontaneous bleeding
Leucorrhoea
Pelvic pain
Urinary tract symptoms
Digestive symptoms
140 (83.3%)
66 (39.23%)
47 (28%)
5 (2.98%)
3 (1.80%)
Tumor’s characteristics
Size
Range
Median
< 4 cm
> 4 cm
2 – 10 cm
5 cm
64 (38%)
104 62%
Macroscopic aspect
Exophytic lesion
Ulcerative lesion
Exophytic + Ulcerative
Infiltrative
77 (45.8%)
15 (9%)
55 (32.7%)
21 (12.5%)
Vaginal extend
Fornix invasion
Upper 1/3 of vagina
Upper 2/3 of the vagina
Lower 1/3 of vagina
27 (16.1%)
65 (38.7%)
33 (19.6%)
10 (6%)
Parametrium extend
Internal 2/3
Entirely infiltrated
120
(71.42%)
87 (51.78%)
21 (12.5%)
Inguinal lymph nodes extend 7 (4.16%)
Histology
Squamous cell carcinoma
Adenocarcinoma
Muco-epidermoid
Papillar carcinoma
147
(87.50%)
19 (11.30%)
1 (0.6%)
1 (0.6%)
Degree of differentiation
Well differentiated
Moderately differentiated
Poorly differentiated
38%
36%
26%
Assessment of the disease extension
Pelvic MRI 82 (48.8%)