Cervical cancer is the second most common cancer among women, with the majority of the cases occurring in low-middle income countries. Data shows a variation in the incidence, with Eastern and Southern Africa shouldering the highest burden of the disease. Notably, close to one third of all global cervical cancer deaths occur in sub-Saharan Africa, a region that has just about 14% of the global female population. The burden of cancer in Africa is further exacerbated by the high prevalence of HIV, the poor coverage of HPV vaccination, low cervical cancer screening.
A review of existing National Cancer Control plans and plans for Non-communicable Disease plans has shown good coverage of measures for physical activity, alcohol consumption, obesity, tobacco, screening, HPV vaccination and WHO essential medicines. Most of these plans lack sections on cost of care, a gap which deserves attention. More so, many patients continue to present with advanced disease, which limits the utility of curative options. Access to radiotherapy services remains a challenge. For example, statistics from Directory of Radiotherapy Centres shows that the number of radiotherapy machines per million population stands at 1.207 for North Africa, and 0.078 for middle Africa, some countries have no known service. The lack of a critical mass trained staff to deliver quality comprehensive cancer care also remains a challenge in Africa.

A minimum package for women with cervical cancer has been proposed, and should be popularised. Countries are scaling up cervical cancer screening services for early detection and treatment, but given that most patients present with advanced disease, palliative care should be an integral part of the cervical cancer control and treatment package. Integration of cervical cancer screening within the public health mainstream and strengthening referrals to palliative care services for those with complex symptoms and concerns equally warrants attention.

TOPIC: CURRENT STATUS OF CANCER IMAGING IN GHANA

Introduction
Currently Multi disciplinary team (MDT) is used in the management of cancers in Ghana.
It Composes of;
1. Oncologist
2. Pathologist
3. Radiologist
4. Nutritionist
5. Surgeon in that specialty

Screening programs
No national screening programmes are available as at now.

Intervention
City cancer challenge a project with the engagement as follows;
1. Needs assessment
2. Activity planning
3. Implementation planning.
4. Implementation

Current status of cancer imaging
Imaging modalities available in ghana include the following;
1. Plain X-ray
2. Mammogram without tomosynthesis,stereostatic biopsy or wire localization.
3. Ultrasound ( superficial & Endoluminal)
4. Barium & intravenous pyelography (IVP) study under flouroscopy
5. Endoscopy
6. Computed tomogram (CT) Scan
7. Magnetic Resonance Imaging (MRI)
o SPECT computed tomogram two are under installation in the country.
o PET CT in the long term as part of the city cancer challenge.

Case presentation
o A 40 year old G4P3 woman was seen at the gynaecology MDT with cervical cancer at 20 weeks gestation.
o She had never had screening for cervical or breast cancer.
o MRI was used for tumour staging and USG for follow up until delivery.
o She was managed with chemoteraphy and delivered a health baby to a healthy mother at 37W4D through caesarian section (C/S).
o Hysterectomy with BSO were done as definative management after delivery.
o Patient and baby are still well 4 years post intervention and delivery.

Conclusion
MDT is needed for accurate diagnosis and management of our cancer cases.
Standard guidelines and SOP’s are to be adhered to for accurate patient management.