Ovarian Cancers in a Northern Nigerian Hospital: Epidemiology, Clinicopathology and Treatment Options

Abstract

Background: In Nigeria, Ovarian cancer is the most lethal gynaecologic cancer. The management of disease in developing countries poses a huge challenge due to late presentation and/or diagnosis, poverty, poor health insurance coverage, and the dearth of specialists in the region amongst others. Record keeping is poor. Treatment options are limited with high default rates and mortality. This was a five-year review of clinicopathology and treatment strategies for ovarian cancers in Ahmadu Bello University Teaching Hospital, Zaria.

Methodology: A retrospective study of all primary ovarian cancers diagnosed and or treated in ABUTH Zaria from 1st January 2016 to 31st December 2020 was carried out. A total of 38 cases were retrieved and relevant data was extracted. The data collected were entered into Open Data Kit (ODK) and analysed using descriptive statistics.

Results: Most patients were aged 35 to 54 years with an overall mean age of 51.2 ±13.8 years. Only 34% of patients were nulliparous and 63.2% were post-menopausal. The commonest symptoms were abdominal swelling (94.7%), and abdominal pain (68.4%). Epithelial carcinomas (81.8%) were the commonest histotype of which serous adenocarcinoma (85.1%) was the commonest. There was no distinction between high-grade and low-grade serous carcinomas. Rare ovarian tumours (germ cell and sex cord/stromal) accounted for 18.2%. Most patients presented with stage III disease and above (77.7%) with no one presenting at stage I. Thirty-five patients (92.1%) had surgery, twenty-four (63.2%) had chemotherapy and four patients (10.5%) had targeted therapy. No patient had hormonal therapy, genetic testing, Poly-adenosine diphosphate-ribose polymerase inhibitors (PARPi), Hyperthermic intraperitoneal chemotherapy (HIPEC), or palliative radiotherapy. Only 12% had an MDT discussion. One-year post-diagnosis, the majority were lost to follow-up (73.7%) while 21.1% of patients were still on follow-up.

Conclusion: Ovarian cancer patients in ABUTH were relatively younger, unemployed, multiparous, and symptomatic. Some standards of care management practices were omitted.