Human Papillomavirus and Cervical Cancer

Cervical cancer is by far the most common HPV-related disease. About 99.7% of cervical cancer are caused by persistent genital high-risk human papillomavirus (HPV) infection. Worldwide, cervical cancer is one of the most common cancer in women with an estimated 528,000 new cases reported in 2012. Most HPV infections clear spontaneously but persistent infection with the oncogenic or high-risk types may cause cancer of the oropharynx and anogenital regions. The virus usually infects the mucocutaneous epithelium and produces viral particles in matured epithelial cells and then causes a disruption in normal cell-cycle control and the promotion of uncontrolled cell division leading to the accumulation of genetic damage. There are currently two effective prophylactic vaccines against HPV infection in many developed countries and these comprise of HPV types 16 and 18, and HPV types 6, 11, 16 and 18 virus-like particles. HPV testing in the secondary prevention of cervical cancer is clinically valuable in triaging low-grade cytological abnormalities and is also more sensitive than cytology as a primary screening. If these prevention strategies can be implemented in both in developed and developing countries, many thousands of lives could be saved

Utilization of Cancer Information System for Breast Cancer Control in Lagos, Nigeria

Introduction: there is a substantial increase in the incidence of breast cancer in Nigeria usually with the late stage presentations and subsequent poor rates of survival attributed mainly to a low level of cancer awareness and ignorance amongst patients. Cancer information system (CIS) is now assuming an emerging role in this respect. Methods: this was a descriptive study carried out over a one year period using a health communications program comprising of 3 breast help lines. An initial period of public awareness was carried out over a 3 months period after which members of the public were encouraged to call the help lines. Breast cancer information was provided and the socio-demographic characteristics and other relevant data of the callers were recorded by the information specialists.  Results:  a total of 294 people were reached during the study period. Majority of the callers (82%) sought information for themselves while the remaining 18% called on behalf of a loved one or friend. Majority [248 (84.3%)] of callers had no breast abnormality, 38 (13%) called to report breast abnormalities and required information on what to do and 8 (2.7%) were breast cancer patients who required information on how to live and cope as breast cancer survivors. Conclusion: the rapid growth of mobile phone use in the Nigeria has presented a unique opportunity and promise to improve cancer care. There is evidence to suggest that mHealth can be used to deliver increased health care services to the increasing population of cancer patients in Nigeria.The Pan African Medical Journal 2016;2

Review of immunohistochemical typing of endometrial carcinoma at the Lagos University Teaching Hospital

Background: Categorization of endometrial carcinomas as type I and II provides useful insights into their different risk factors, pathogenesis and biologic behaviours. Aim: To determine the immunohistochemical classifications of endometrial carcinomas in Nigerian women. Design: A retrospective review of histopathologic slides of cases of endometrial carcinomas seen at the Lagos University Teaching Hospital (LUTH) over a 5-year period. The slides were reviewed, and the diagnoses made according to the WHO nomenclature. The classification of endometrial carcinomas into Type I and II was made by immunohistochemistry using antibodies to ER, PR, p53 and Ki-67. Results: Eight cases of endometrial adenocarcinoma were reported accounting for 53.3% of all endometrial malignancies. Of these, only 1 case showed the classic type I immunophenotype while type II staining pattern was seen in 4 cases. The remaining 3 cases had equivocal immunophenotypes: one was p53+ but showed ER+, PR+ and high Ki-67 index; the second was p53-, ER+, PR+ but had a high Ki-67 expression; while the last was p53-, but ER-, PR- and had high Ki-67 expression. Conclusion: Endometrial carcinomas in Nigerian women are more likely to be type II carcinomas. A reasonable proportion of the cases were equivocal thus requiring further categorization with molecular studies

Chlamydia trachomatis among women with normal and abnormal cervical smears in Lagos, Nigeria

Background: Chlamydia trachomatis is one of the most common sexually transmitted disease agents. Cervical intraepithelial neoplasia (CIN) has been independently associated with serological evidence of chlamydial infection. This study therefore was aimed to determine the prevalence of C. trachomatis and the association between Chlamydia trachomatis infection and cervical intra-epithelial lesion.Methods: It is a cross-sectional case control study carried out at the Lagos University Teaching Hospital (LUTH) with the study participants selected into 2 groups: the case group (women with abnormal smears) and the control group (women with normal Pap smear). Relevant information was obtained using a structured interviewer-administered questionnaire. Endocervical swab sample was collected and analysed by Polymerase Chain Reaction (PCR) test. Data analysis was done using Epi-Info statistical package (version 3.4.3).Results: The overall prevalence of C. trachomatis was 27.7% with a decreasing trend noted with age (P <0.05). The majority of women with C. trachomatis were in the reproductive age group of 25-45 years. 50% of women with abnormal smears were positive for C. trachomatis, compared to only 16.7% of the controls (X2 = 10.95; P = 0.001). There was no statistically significant association between prevalence of C. trachomatis and cervical cytological types (X2 = 1.892; P = 0.595)Conclusions: The study revealed an association between Chlamydia trachomatis and precancerous lesions of the cervix. Routine screening and treatment of sexually active adolescents and women in the reproductive age group is recommended as an indirect measure to reducing the incidence of cervical cancer in Nigeria

Placental weight and perinatal outcome among parturients at a university teaching hospital in Lagos, Nigeria

Background: The growth and survival of the fetus are essentially dependent on formation, full development, and functions of the placenta. Examination of the placenta would demonstrate important information about whatever has happened to the fetus in utero.Aim: The aim of this study was to determine the sociodemographic characteristics that affect placenta weight and then assess the association between placental weight and perinatal outcome among parturients in a tertiary hospital in Lagos, Nigeria.Materials and Methods: This was a retrospective review of all women who delivered at the labor ward complex of the hospital between January 2014 and December 2015. The data of all parturients with uncomplicated singleton pregnancies were obtained from the labor ward register, and their case notes were subsequently retrieved from the medical records department for extraction of all relevant information. Descriptive statistics were computed for all data and analyses were done using Statistical Package for the Social Sciences version 22.0 for Windows (manufactured by IBM Corp., Armonk, New York, United States). The associations between groups of continuous variables were tested using the independent sample t‑test or one‑way analysis of variance where applicable. All significances were reported at P &lt; 0.05.Conclusion: Parity, maternal booking weight, gestational age at delivery, baby’s birth weight, umbilical cord length, and neonatal 5‑min Apgar score had positive correlations with placental weight. Further longitudinal studies are needed to examine the extent to which placental weight will affect the future growth and development, nutritional status, and health of newborns.Result: The overall mean cord length was 59.6±11.7cm and the mean placental weight was 657.5±96.1 grams with majority (46.3%) of the parturients having normal placental weight range of 500-749 grams. Placental weights at term have statistically significant positive correlations with the gestational age at delivery (P = 0.041), baby’s birth weights (P = 0.003), 5-minute Apgar score (P = 0.016), and the umbilical cord length (P = 0.035).Keywords: Baby’s weight; maternal booking weight; parity; placental weigh

A rare case of ovarian dysgerminoma in a 6‑year old child in Lagos: A case report

Dysgerminoma is the most common malignant germ cell tumor in children and adolescents. Most cases occur in the 2nd and 3rd decades of life, but 10% of cases occur in the 1st decade of life. The rarity of this malignancy in prepubertal children and the recognized controversies in its management prompted this case report. The case of a 6‑year‑old girl who had laparotomy and unilateral adnexectomy with subsequent histological diagnosis of an ovarian dysgerminoma was presented. Prognosis depends on the stage of the tumor at presentation, and conservative surgery should be the aim during the initial treatment. Adoption of multidisciplinary management within an oncology board with joint decision on the need for adjuvant chemotherapy for early stage diseases will confer good prognosis.Keywords: Germ cell tumor; malignant; management; multidisciplinar

A 10-year review of the pattern of use of intrauterine contraceptive device among women seeking contraception at the Lagos University Teaching Hospital

Background: Intrauterine contraceptive devices (IUCDs) are the most frequently used method of reversible female contraception worldwide, but their utilization varies considerably in different countries. Objectives: The objective of this study is to determine the pattern of use of IUCD, sources of referral, its associated complications and reasons for its discontinuation over a 10-year period. Materials and Methods: This was a retrospective study of all the women who sought contraceptive services at the Family Planning Clinic of the Lagos University Teaching Hospital over a 10-year period (January 1, 2006, to December 31, 2015). The case notes of these women were retrieved and relevant data extracted. Descriptive statistics were computed for the data, and results were presented in simple tables and charts. Results: A total of 1726 women accessed contraceptive services during the period under review with 521 (30.2%) choosing IUCD as their preferred method. A majority of the clients were aged between 30 and 34 years (34.5%) and multiparous (92.3%). The largest proportion of the studied clients (71.9%) had up to the tertiary level of education with the majority of the referrals coming from nurses (39.5%) and doctors (20.0%). The most common undesirable effect reported by the clients was abnormal vaginal discharge (40.8%) while 40.7% of the women discontinued the use of the IUCD prematurely. The most common reason for discontinuing the use of IUCD was the occurrence of an undesirable effect (44.8%). Conclusions: Our study revealed a modest decline in the uptake of IUCD among contraceptive users in Lagos. Health-care providers still appear to be the best source of information and referral as they play a crucial role in influencing women's acceptability of these services

Risk predictors of early recurrence in women with epithelial ovarian cancer in Lagos, Nigeria

Introduction:&nbsp;epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer with a recurrence rate as high as 85% after an initial treatment. However, there are currently no reliable means of predicting the risk of recurrence after first-line treatment. This study investigated the risk factors that predict early recurrence of EOC after primary treatment among women in Lagos, Nigeria. Methods:&nbsp;this was a retrospective cohort study involving the review of all histologically confirmed EOC patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. A study proforma was used to retrieve relevant information and descriptive statistics were computed for all data. The associations between variables were tested and multivariate analysis was done to adjust for all the possible characteristics that predict early EOC recurrence. Results:&nbsp;the rate of recurrence of EOC was 76.4%. Suboptimal debulking surgery is the only independent predictor of early tumour recurrence. Conclusion:&nbsp;women should be adequately counselled and encouraged to report their symptoms early to ensure optimal primary treatment. Strategic efforts should also be made to further improve subspecialty training programs and skills development in gynaecological oncology in Nigeria and sub-Saharan Africa

Prevalence and risk factors for genital high-risk human papillomavirus infection among women attending the outpatient clinics of a university teaching hospital in Lagos, Nigeria

Introduction: Cervical cancer is the second most common cancer among women in the developing countries and the seventh commonest cancer in the developed countries. Human papillomavirus (HPV) is now known to be the main factor in the aetiology of cervical cancer with over 99.7% of cases being associated with previous high risk HPV (hrHPV) infection. This study was aimed to determine the prevalence and risk factors for genital hrHPV infection among women attending the out-patient clinics of the Lagos University Teaching Hospital.Methods: This was a cross-sectional study involving a total of 200 women. Questionnaires were administered to collect data such as sociodemographic, reproductive and sexual histories. Endocervical swab samples were then taken from each participant. Samples were analyzed by polymerase chain reaction (PCR) using consensus primers targeted against the hrHPV viruses.Results: The prevalence of hrHPV in the study was 36.5%. The most predominant HPV subtypes were 31 (25.0%), 35 (8.0%) and 16 (3.5%) with the largest proportion (76.1%) of the tested samples being positive for only a single hrHPV subtype. The study showed statistically significant associations between early age at coitarche (P = 0.032) and increasing number of lifetime sexual partners (P = 0.001) with genital hrHPV infection.Conclusion: The prevalence of hrHPV was high in Lagos with the majority of test positive samples having only a single HPV genotype. We demonstrated early age of sexual debut and increasing number of lifetime sexual partners as the most important factors associated with genital hrHPV infection.Keywords: Genital, genotypes, hrHPV, LUTH, PCR, vaccinatio