Clinical-pathological presentation, treatment and outcomes of ovarian cancer cases at moi teaching and referral hospital (mtrh), eldoret

Introduction: Ovarian cancer is the third most frequent cause of death amongst gynecological cancers both locally and globally. It presents with vague nonspecific symptoms and is histologically heterogeneous. Ovarian cancer management is primarily surgical followed by adjuvant chemotherapy depending on the histological type and the surgical stage. Objectives: To determine the clinical-pathological presentation, treatment and outcomes of ovarian cancer patients at Moi Teaching and Referral Hospital (MTRH), Eldoret. Methods: This was a retrospective chart review of ovarian cancer patients managed between January 2010 and August 2017 at MTRH. Data were analyzed using STATA version 15. Survival trends were generated using Kaplan Meier method. Results: A total of 124 medical charts of patients with ovarian cancer were retrieved, 29 had incomplete data and were excluded, and 95 were evaluable and included in this review. Over half, (63%) presented in stage 3 and 4 though there was no significant association between histology and stage of disease [X2(6) =4.72, p=0.58]. The median age at diagnosis was 47 years with 55-80 years being the modal age group (36%). Majority (57%) were married and 83.9% were unemployed. Only 66% had documented histopathology, with Epithelial Ovarian Cancer (EOC) being most common (70%), [serous (50%) and mucinous (11.4%)]. Sex cord stromal tumors 11%. Germ cell tumors amounted to 11% (dygerminomas 50%and Yolk sac tumors (25%) Bivariate analysis revealed significant association only between histology and parity [X2 (6) = 28.8, p\u3c0.001]. Those reviewed contributed a total of 138.2 person-years to the study and 11(12%) died, giving a diseasespecific mortality rate of 79.6 per 1,000 person years (95% CI: 44.1-143.8). Mortality was highest among those with epithelial histology 109 (95% CI: 48.8-241.9) per 1,000 person years and those who had neoadjuvant chemotherapy then surgery as a treatment option, 373.1 (95% CI: 93.3-1491.8) per 1,000 person years. Those who underwent upfront surgery followed by adjuvant chemotherapy and sex cord stromal cancer had higher survival probability. Conclusion: Ovarian cancer at MTRH is diagnosed at advanced stages III and IV of disease and has a lower median age at presentation. EOC is the commonest histological type and serous subtype is the most lethal. Mortality was highest among those with EOC and those who underwent neoadjuvant chemotherapy. Granulosa cell tumor is the only sex cord stromal type reported in our setting and it exhibited a higher survival probability. Germ cell tumors were mainly found in nulliparous women

Epidemiological profile and clinico-pathological features of pediatric gynecological cancers at Moi Teaching & Referral Hospital, Kenya

Background: The main pediatric (0–18 years) gynecologic cancers include stromal carcinomas (juvenile granulosa cell tumors and Sertoli-Leydig cell tumors), genital rhabdomyosarcomas and ovarian germ cell. Outcomes depend on time of diagnosis, stage, tumor type and treatment which can have long-term effects on the reproductive career of these patients. This study seeks to analyze the trends in clinical-pathologic presentation, treatment and outcomes in the cases seen at our facility. This is the first paper identifying these cancers published from sub-Saharan Africa. Method: Retrospective review of clinico-pathologic profiles and treatment outcomes of pediatric gynecologic oncology patients managed at MTRH between 2010 and 2020. Data was abstracted from gynecologic oncology database and medical charts. Results: Records of 40 patients were analyzed. Most, (92.5%, 37/40) of the patients were between 10 and 18 years. Ovarian germ cell tumors were the leading histological diagnosis in 72.5% (29/40) of the patients; with dysgerminomas being the commonest subtype seen in 12 of the 37 patients (32.4%). The patients received platinum-based chemotherapy in 70% of cases (28/40). There were 14 deaths among the 40 patients (35%) Conclusion: Surgery remains the main stay of treatment and fertility-sparing surgery with or without adjuvant platinum-based chemotherapy are the standard of care with excellent prognosis following early detection and treatment initiation. LMICs face several challenges in access to quality care and that affects survival of these patients. Due to its commonality, ovarian germ cell cancers warrant a high index of suspicion amongst primary care providers attending to adnexal masses in this age group

Cisplatin for The palliative treatment of cervical cancer at Moi Teaching and Referral Hospital, Eldoret, Kenya: A two-year experience

Objective: In Sub Saharan Africa access to radiation therapy for women with advanced cervical cancer is poor due to the scarcity of radiation machines. In Kenya there is one public functional cobalt machine for a population of 40 million. The cost both direct and indirect are mostly too high for women. We adapted the use of Cisplatin 50 mg/m2 with a 3-4 week interval as an alternative. The effect of this treatment for symptom control is evaluated. Methods: Women with advanced stage cervix cancer who were not able to go for radiotherapy were planned for palliative chemotherapy with cisplatin 50 mg/m2 iv in combination with iv fluids and antiemetics. We continued chemotherapy until symptoms had subsided or to a maximum of 6 cycles. All women that were offered palliative chemotherapy were included for this study. Data were collected systematically at every visit and captured in an electronic database. Results are evaluated using a descriptive analysis. Results: In 2011 and 2012 88 women were planned for palliative chemotherapy. 61 went on to have at least one course of chemo. The women not getting chemo progressed quickly, were unfit due to kidney failure, sought treatment elsewhere or were lost to follow up. Stage was distributed as follows: FIGO Stage 1 1.1%, 2A 1.1% (both women delayed treatment and came back with advanced stage), 2B 9.1%, 3A 24%, 3B 55%, 4A 9.1%. The median number of three courses were given (range 1-6) On presentation 88% of women had bleeding, 69% had discharge and 67% complained of pain. For the women that got at least one course of chemo and who could be evaluated during a follow up visit, bleeding improved for 37/43(86%) women, discharge improved for 28/36(78%) women and pain improved for 24/35(69%) women. Conclusion: Prior to initiating this program advanced cervical cancer patients who presented to hospital were transfused and sent home to die. We have demonstrated that palliative chemotherapy with Cisplatin is feasible and effective in a low resource setting. Bleeding, discharge and pain all improved for the majority of patients who presented to hospital with advanced cervix cancer

Cervical cancer treatment for operable lesions in a low-resource contemporary setting

Background: To compare HIV+ and HIV- women with operable cervical cancer in a low resource contemporary setting. Methods: A retrospective study using well-matched controls from a Kenyan teaching and referral hospital. Results: 183 women were treated for cervical cancer between October 2007 and June 2011. The histologic subtype was squamous cell in all but one case. At presentation, 28 had operable lesions (Stage IA1–IIB1); 7 more received neoadjuvant chemotherapy prior to surgery. HIV seroprevalence was 54% (18/33) among initial operative cases and 57% among the neoadjuvant group (p=ns). Mean age was 42 (HIV+), and 43 (HIV-), (range 25-64). HIV- vs. HIV+ cervical cancer patients (mean CD4 count 373, 50%\u3c200) were detected by visual inspection with acetic acid (VIA) (18% (2/11)vs 68% (15/22) p=.099), symptoms (27%(3/11) vs 14%(3/22) p=.43), or Pap smear (45% (5/11) vs .09% (2/22) p=.06), respectively.HIV+ patients (two Stage IB1, two Stage IB2) did not require more downstaging than HIV- patients (two stage IIB, one stage IIIA) before surgery (18% (4/22) vs 27% (3/11) p=.63). Surgical treatments were not statistically different in either group and included radical hysterectomy(25), total abdominal hysterectomy(2), cesarean hysterectomy(1), and total vaginal hysterectomy(5). Postoperative complications included fever, dehiscence, DVT, ileus, fistula, and infectious complications (chest, urinary tract, wound). One HIV- patient suffered postoperative fever, vesicovaginal fistula, and wound dehiscence (overall complications .06%).Lymph node involvement was noted in 7 HIV+ and 3 HIV- patients who underwent full staging procedures (p=.004). Conclusions: In patients with operable cervical cancer, HIV serostatus does not affect complication rate or influence need for downstaging prior to surgery compared to a well-matched control group. HIV+ patients were not more likely to receive neoadjuvant chemotherapy but were more likely to have positive lymph nodes. VIA detected the majority of cervical cancers HIV+ patients