A Six-Year Study of the Clinical Presentation of Cervical Cancer and the Management Challenges Encountered at a State Teaching Hospital in Southeast Nigeria

Cervical cancer is still a major contributor to cancer-related mortality amongst women living in poor, rural communities of developing countries. The objective of this study is to establish the clinical presentation of cervical cancer and the management challenges encountered in Abakaliki, southeast Nigeria, with a view to finding intervention strategies. This study is a retrospective descriptive assessment of cases of clinically diagnosed cervical cancer managed at a state teaching hospital over six years. Of 76 cases managed, 61 (80.3%) cases notes were available for study. The mean age and parity of patients were 53.8 years and 6.8 years, respectively. The majority (75.4%) were illiterate. All had been married, but 42.6% were widowed. The main occupations were farming or petty trading. One patient (1.6%) had had a single Pap smear in her life. The major presenting complaints were abnormal vaginal bleeding (86.9%), offensive vaginal discharge (41.0%), and weight loss. Twenty patients (32.8%) were lost to follow-up prior to staging. Of the remaining 41 patients, 16 (39.0%) had stage III disease and 17.1% stage IV. Fifteen patients (24.6%) with late stage disease accepted referral, and were referred for radiotherapy. Those who declined were discharged home on request, though 4 (9.8%) died in the hospital. There was no feedback from referred patients confirming that they went and benefitted from the referral. The presentation followed known trends. Illiteracy, poverty, early marriages, high parity, widowhood, non-use of screening methods, late presentation, non-acceptance of referral, and lack of communication after referral were some of the major challenges encountered. These underscore the needs for health education and awareness creation, women educational and economic empowerment, legislation against early marriages and in protection of widows, and creation of a well-staffed and well-equipped dedicated gynecologic oncology unit to forestall further referral

Histopathological patterns of childhood malignancies seen at Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria: A 10 year retrospective study

Introduction: Childhood malignancies (CM) have been one of the major causes of death in the world. It appears to be increasing in significance due to the ongoing reduction in both infectious and nutritional diseases.Aims: The study was conducted to document the histopathological pattern, age and sex distribution of childhood malignancies in a University Teaching Hospital in Southeast Nigeria.Method: The materials consisted of histology slides, formalin-fixed paraffin-embedded tissue blocks (FPTB), and requisition forms of all cases diagnosed with CM at a University Teaching Hospital between the periods January 2005 and December 2015Results: A total of 2,528 surgical biopsies were received at the Department. Only 60 (2.4%) specimens represented childhood malignancies. Thirty-one cases (51.7%) of the entire CM were lymphomas; 12 (20.0%) were non-Hodgkin lymphoma, 17 (28.3%) others were Burkitt’s type whereas 2(3.3%) were Hodgkin lymphoma. Childhood malignancies were more in males 36 (60.0 %) than females 24 (40.0%), giving a male to female ratio of 3:2. However, Burkitt’s lymphoma was higher in females 12 (70.6%) than males 5 (29.4%) with a male to female ratio of 1.2:3. Twenty-six (43.3%) cases of the CM occurred in children aged 0-5 years but 20 (36.7%) presented in children aged 11 to 15 years. Twelve (20.0%) cases were seen in children 6 to 10 years. Six (23.1%) of the children had Burkitt's lymphoma all of whom were under 5 years.Conclusion: Lymphomas were the commonest CM, Burkitt’s lymphoma being the dominant subtype in this study. There was a female preponderance of Burkitt’s lymphoma

An Assessment of Ovarian Cancer Histotypes Across the African Diaspora

ObjectiveOvarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. MethodsPatients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at pResultsNigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7 +/- 12.8 years) relative to USB (58.9 +/- 15.0) and CBB (59.0 +/- 13.0,p<0.001). Black women [CBB (25.2 +/- 15.0), Nigerians (29.5 +/- 15.1), and USB (33.9 +/- 17.9)] were diagnosed with GCT younger than White women (35.4 +/- 20.5, p=0.011). Black women [Nigerians (47.5 +/- 15.9), USB (50.9 +/- 18.3) and CBB (50.9 +/- 18.3)] were also diagnosed with SCST younger than White women (55.6 +/- 16.5, p<0.01). ConclusionThere is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation