Management in Patients with Advanced Cancer Cervix in Low Resource Setting

Subjects with an advanced stage of cervical cancer have bleeding which can be alarming to the family as well as treating staff. Sometimes,life threatening bleeding occurs. Pre-planning is required in all bleeding situations, especially in advanced stage patients and in those with the potential for massive bleeding. Interventions are based on prognosis , effectiveness, patient preferences and past medical history.In low resource settings we need to modify our treatment plan. Bleeding in patients with advanced cancer can be due to variety of underlying processes and presents clinically in different ways, from chronic, low-volume bleeding to acute episodes of major haemorrhage. Depending on whether the bleeding is originating from capillaries or from larger vessels will affect the treatment plan. Local modalities available to manage bleeding these include topical hemostatic agents and dressings, radiotherapy, endoscopic procedures, and TAE or balloon placement through interventional radiology. There is increase in use of interventional radiology. Patients at risk for major hemorrhages should be identified, and their families and caregivers should be prepared. End-of-life decision making should be based on comfort and the optimization of quality of life.