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

Radical hysterectomy for operable early cervical cancer in HIV-positive and HIV-negative women in western Kenya

Radical hysterectomy is well tolerated with no increase in complications in HIV-infected women and is an appropriate form of treatment for early-stage cervical cancer in HIV-infected women

Prenatal cervical cancer screening using visual inspection with acetic acid in a low resource setting

Purpose: Cervical cancer is one of the most common malignancies among women in low resource setting. The objective of this study was to assess the acceptability of prenatal cervical cancer screening using visual inspection with acetic acid (VIA) in a low resource setting. Methods: This was a cross-sectional study conducted at Moi Teaching and Referral Hospital. Over a period of 12 months, we enrolled 331 women who were attending antenatal care clinic with a gestation of age of less than 22 weeks. We screened them for cervical cancer by applying 5% acetic acid to the cervix (VIA Method). Visualization of aceto-white lesions was interpreted as a positive VIA test. A cervicography was obtained for independent review by two clinicians. A repeat VIA test or colposcopy and biopsy were recommended at 6 weeks postpartum for those with a positive VIA test. Results: Mean gestational age was 16 weeks. Seventy five percent of participants (n = 247) had used contraceptives, 31.1% (n = 103) had previously been screened for cervical cancer and 9.1% (n = 14) were HIV positive. The study clinician detected 11.3% VIA positive while first and second independent reviewers reported 22.5% and 7.7% VIA-positive results, respectively. About 85.7% of the participants did not experience any immediate adverse reaction as a result of the procedure. However, 3.8%, 38.4% and 0.7% experienced pain, burning sensation and bleeding respectively. Overall, 98.4% (n = 306) indicated that they would recommend the test, and 99% (n = 307) indicated that they would return for a repeat test 6 weeks postpartum. HIV status had no influence on VIA-positive rates (p = 0.909). Conclusion: The rate of VIA positive was 13.8% among the pregnant women. It is acceptable to use VIA to screen pregnant women for cervical cancer

Low sensitivity of the careHPV™ Assay for detection of oncogenic Human papillomavirus in cervical samples from HIV-infected and HIV-uninfected Kenyan women

Background: Human papillomavirus (HPV) infection causes cervical cancer (CC), a common malignancy among Kenyan women. New CC screening methods rely on oncogenic HPV (“highrisk”, or HR-HPV) detection, but most have not been evaluated in swabs from Kenyan women. Methods: HPV typing was performed on 155 cervical swabs from Kenyan women using the Roche Linear Array® (LA) and careHPV™ (careHPV) assays. Detection of 14 oncogenic HPV types in careHPV assay was compared to LA results. Results: Compared to LA, sensitivity and specifi city of careHPV assay was 53.0% and 80.9%, respectively. The sensitivity and specifi city of careHPV in swabs from women with cervical dysplasia was 74.1% and 65.2%, respectively. The sensitivity and specifi city of careHPV in swabs from HIV-infected women was 55.9% and of 96.4%, respectively. Overall agreements of careHPV assay with LA was substantial. Conclusion: The results for careHPV assay are promising for oncogenic HPV detection in Kenyan women. The low sensitivity of careHPV for detection of HR-HPV could limit it’s benefi t as a screening tool. Thus, a full clinical validation study is highly desirable before the careHPV assay can be accepted for cervical cancer screening

Detection of types of HPV among HIV-infected and HIV-uninfected Kenyan women undergoing cryotherapy or loop electrosurgical excision procedure

Objective: To assess the baseline types of HPV infection among HIV-positive and HIV-negative women in western Kenya undergoing cryotherapy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia. Methods: A prospective observational study was conducted of baseline HPV characteristics of women undergoing visual inspection with acetic acid (VIA) and cryotherapy or LEEP. After a positive VIA in HIV-positive and HIV-negative women, data on demographics, CD4 count, and use of antiretroviral therapy and a cervical swab were collected. HPV typing was performed using the Roche Linear Array. Results: Of 175 participants, 86 (49.1%) were HIV-positive and had a higher prevalence of low-risk HPV types (odds ratio [OR] 5.28, P=0.005) compared with HIV-negative women. The most common high-risk (HR)-HPV types in HIV-positive women were HPV 16 (13.9%) and HPV 18 (11.1%). HIV-positive women requiring LEEP were more likely to have HR-HPV types (OR 6.67, P=0.012) and to be infected with multiple HR-HPV types (OR 7.79, P=0.024) compared to those undergoing cryotherapy. Conclusion: HIV-positive women requiring LEEP versus cryotherapy had a higher prevalence of any HR-HPV type and multiple HR-HPV types. There were no such differences in HPV types identified among HIV-negative women

Human immunodeficiency virus type 1 RNA genital tract shedding after cryotherapy for cervical intraepithelial neoplasia in Western Kenya

Abstract :This prospective study of 39 women living with human immunodeficiency virus (HIV) on antiretroviral therapy in Western Kenya aimed to quantify genital tract HIV-1 RNA (GT-HIV RNA) shedding before and after cryotherapy for cervical intraepithelial neoplasia. Most GT-HIV RNA shedding was detected precryotherapy, suggesting that cryotherapy was not the primary cause of shedding

HIV-1 RNA genital tract shedding after cryotherapy for visual inspection with acetic acid-positive cervical lesions in western Kenya

Objectives: To quantify genital tract HIV-1 RNA (GT-HIV RNA) shedding among women living with HIV (WLHIV) before and after cryotherapy treatment for visual inspection with acetic acid (VIA) positive cervical lesions. Methods:We conducted a prospective, longitudinal study of 39 WLHIV on antiretroviral treatment (ART) undergoing cryotherapy for VIA positive lesions in Kenya from 2015-2017. Eligibility for cryotherapy were lesions that covered Results: Detectable GT-HIV RNA was found in 4/39 (10%) participants pre-cryotherapy, 1/30 (3.3%) and 3/26 (11.5%) participants at the 2- and 8-weeks post-cryotherapy, respectively. Only 6/39 (13%) participants had detectable GT-HIV RNA at any point during the study. 2/6 had recent high PVL (range: 49,124-150,695 copies/mL) within 3 months of starting the study and detectable GT-HIV RNA at follow-up visits. 4/6 had undetectable recent PVL within 3-11 months of the study but each had detectable GT-HIV RNA pre-cryotherapy. The mean GT-HIV RNA among 4/39 WLHIV with shedding at pre-cryotherapy was 43,109 (range: 21,812-73,625) copies/mL. Only one participant had GT-HIV RNA (73,125 copies/mL) at 2-weeks post-cryotherapy (N=30); she had no shedding pre-cryotherapy but had a PVL of 49,124 copies/mL 3 months before the study. The mean GT-HIV RNA at 8-weeks post-cryotherapy (N=26) was 44,668 (range: 21,256-64,812) copies/mL among three participants. One of the 3 had high PVL of 150,695 copies/mL 3 months prior to cryotherapy while 2/3 had GT-HIV RNA shedding at baseline despite undetectable most recent PVL. However, their undetectable PVL was 8-11 months prior to cryotherapy which may not accurately reflect PVL at baseline. Conclusions: The majority of GT-HIV RNA shedding was detected before cryotherapy. This finding suggests that cryotherapy was not the primary cause of GT-HIV RNA shedding. Non-adherence to ART might have played a major role. The small sample size and failure to perform paired GT-HIV RNA and PVL tests at each visit are limitations of the study. Further research on the effect of cryotherapy on GT-HIV RNA shedding in ART non-adherent compared to ART-adherent WLHIV is needed

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

Knowledge of Cervical Cancer and Acceptability of Prevention Strategies Among Human Papillomavirus-Vaccinated and Human Papillomavirus-Unvaccinated Adolescent Women in Eldoret, Kenya

Cervical cancer is a critical public health concern in sub-Saharan Africa. Adolescents are key targets in primary prevention strategies. Following a human papillomavirus (HPV) vaccination initiative (Gardasil) in Eldoret, Kenya, the knowledge and source of information of cervical cancer and acceptance of prevention strategies among vaccinated and unvaccinated adolescents were evaluated. A cross-sectional comparative study enrolled 60 vaccinated and 120 unvaccinated adolescent women. Institutional ethical approval was obtained and signed consent was obtained from the parents. Data collection was performed using interviewer-administered questionnaires derived from factual statements based on information from print material used for community sensitization on cervical cancer. The median age of the participants was 14.0 years (interquartile range [IQR] = 13.0-15.0). Of 60 vaccinated adolescents, 56 (93.3%) had heard of the HPV vaccine compared with 6 (5%) of unvaccinated participants (p < 0.001). Of 60 vaccinated participants, 58 (96.7%) had heard of cervical cancer compared with 61 (50.8%) unvaccinated participants (p < 0.001). Both cohorts identified the school as the main source of information for cervical cancer. The two groups also showed similarity in their selection of cervical cancer prevention strategies acceptable to them such as delaying sexual debut, limiting number of sexual partners, and use of condoms for protection against sexually transmitted infections. Of 120 unvaccinated participants, 63.7% expressed willingness to be vaccinated. Exposure to the HPV vaccine was associated with a higher knowledge of cervical cancer. The adolescents predominantly rely on the school for health information. Both cohorts of adolescents showed remarkable acceptability for cervical cancer prevention strategies

Is there value to sub-specialty training in sub-Saharan Africa?

Over the past three decades, Africa has focused on combatting infectious diseases, such as tuberculosis, malaria, and HIV/ AIDS. As treatment strategies for infectious diseases have improved over time, life expectancy has increased, shifting the burden to chronic diseases, such as cancer. The WHO has now identified non-communicable diseases, including cancer, as the new epidemic in sub-Saharan Africa1. Cancer incidence and mortality are increasing rapidly in low and middle-income countries (LMIC) as compared to high-income countries. By 2020, it is predicted that 70% of all new cancers worldwide will occur in LMIC2. In 2012 850 000 new cancers were diagnosed in Africa, and over one million new cancers are predicted on the continent by 20202–4. Developing effective strategies to prevent, detect and treat this growing number of cancer cases poses a great challenge. There is an ongoing lack of resources, and little awareness of the need among policymakers and the general public. In addition, there is a severe shortage of health care personnel in sub-Sharan Africa5–7. With limited resources and a growing need to treat complex malignancies, is it feasible for LMIC to train subspecialists in oncology