Adekunle Oguntayo

Pattern of cervical dysplasia among women of reproductive age in Zaria Northern Nigeria.

Background : Cervical cancer is a preventable and the most common female genital tract cancer despite the availability of screening services for precancerous lesions of the cervix. This study aims to determine the prevalence of cervical dysplasia in women of reproductive age in Zaria. Methodology: A prospective study of 131 women of child bearing age attending the family planning and Gynaecology clinics in Ahmadu Bello University Teaching Hospital, Zaria - Nigeria were recruited for the study after obtaining their consent. Cervical samples were collected and subjected to pap staining and cytological examination by a pathologist and classified using the Bethesda System. The data were processed using Statistical Package for the Social Sciences (SPSS) version 17. Bivariate analysis was done and the level of significance was set at a P Results: Cervical dysplasia prevalence of 7.0% was found out of which High Grade Squamous Intraepithelial Lesion (HSIL) was 2.3% (n = 3), Low Grade Squamous Intraepithelial Lesion (LSIL) was 3.1% (n = 4) and Atypical Squamous Cells of Undetermined Significance (ASC-US) was 1.6% (n = 2). There were 13% (n = 17) inflammatory features. Normal cytological features for Pap smear testing was present in 77.1% (n = 101). Conclusion: These findings underscore the importance of routine screening and early treatment of cervical dysplasia in order to reduce morbidity and mortality associated with cervical cancer.

Epidemiology of ovarian cancers in Zaria, Northern Nigeria: a 10-year study

Background Globally, the absence of a premalignant stage of ovarian cancer and a reliable screening tool make early diagnosis difficult. Locally, poverty, ignorance, and lack of organized cancer services make prognosis poor. We describe the epidemiological features of ovarian cancer seen at Ahmadu Bello University Teaching Hospital Zaria, Northern Nigeria, a tertiary referral center, over a 10-year period in this challenging setting. Methods All cases of histologically diagnosed ovarian cancer between January 1, 2004 and December 31, 2013 were included in the study. Case notes were retrieved to collect clinical data including age, parity, clinical stage of disease at presentation, and known associated factors. Results were analyzed using Epi info™. Results A total of 78 patients were included in the study. About 4–13 cases were seen every year with a tendency to increasing incidence. The patients were aged 8–80 years with mean of 37 years. Sixty-two (79.5%) patients were premenopausal while postmenopausal women accounted for only seven cases or 9.0%. There were 17 cases (22.3%) of aggressive cancers in patients aged ≤20 years. A majority of the patients, 65 (83.3%), were parous with only nine (11.5%) patients being nulliparous. Serous cyst adenocarcinoma accounted for 32 (41%) cases. Granulosa cell tumor was the second commonest with 18 cases (23.1%). The mean age of occurrence of serous cyst adenocarcinoma was 31 years and for epithelial ovarian cancers in general it was 33.5 years. Endometrioid adenocarcinoma was rare with only one case in 10 years. Factors like age, parity, and premenopausal status did not appear to be protective to the occurrence of malignant ovarian tumor in this group. Conclusion Increasing numbers of patients with ovarian cancer were seen over the 10-year period. Young, premenopausal, parous women made up the majority of cases. Serous cystadenocarcinoma was the most common histological variant.

Gestational trophoblastic disease in Abuth Zaria, Nigeria: A 5-year review

Gestational trophoblastic diseases (GTD) includes a spectrum of diseases (tumor or tumor-like conditions) characterised by aberrant growth and development of the trophoblasts that may continue even beyond the end of pregnancy. It encompasses the benign trophoblastic disease (complete and partial moles), and the malignant trophoblastic diseases including the invasive mole (chorioadenoma destruens), choriocarcinoma, and Placental Site Trophoblastic Tumor (PSTT). This study was to determine the prevalence, risk factors, clinical presentation, diagnosis, treatment options and outcomes of GTD in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. A five-year retrospective study of patients with GTD managed at ABUTH, North-west Nigeria, from 1 st January 2008 to 31 st December, 2012 was undertaken. Data of all cases of GTD in the hospital over the 5 year period were obtained. The gynaecology ward and labour ward registers also provided information on the total number of gynaecological admissions and deliveries respectively. The data processing and analysis were carried out using the SPSS software version 16. The data obtained were expressed in percentages, means, and standard deviations. During the period of study there were 8,138 deliveries and 2,453 gynaecological admissions. There were 59 cases of GTD with 41 having choriocarcinoma, 18 molar pregnancies and no case of invasive mole or PSTT. Out of the 41 case folders retrieved, 23 were choriocarcinoma and 18 of molar pregnancies. The prevalence of GTD was 7.2 per 1000 deliveries (0.72% or 1 in 138 deliveries) and constituted 2.4% of gynaecological admissions. Hydatidiform mole (HM) occurred in 1 in 452 deliveries and choriocarcinoma occurred in 1 in 198 deliveries. Ages ranged from 19-49 years with mean of 32.5+ 5.0 years. Most (66.7%) cases of HM were 19-29years while 60.9% of choriocarcinoma cases were 30-39years. Majority of cases were multiparous. The antecedent events predating choriocarcinoma were Hydatidiform mole (31.7%), abortions (29.3%) and 2.4% followed term pregnancy. History of amenorrhea was present in all cases while vaginal bleeding occurred in 97.6%, pallor (87.8%), hyperemesis gravidarum (48.8%) and 4.9% came in shock. Consequently, common complications reported were haemorrhage (90.2%), anemia (87.8%) and shock (12.2%). Pregnancy test was positive in 90.2% of cases and serum beta hCG was done in 24.4% with more than half having a level >12,000miu/ml. All patients had pelvic ultrasound scan and snowstorm appearance occurred in 41% of benign GTD cases. Histology was used to confirm 56.1% cases of choriocarcinoma and 43.9% of molar gestation. Most (94.4%) of HM had suction evacuation while 95.6% of choriocarcinoma cases had chemotherapy, one case (2.4%) had Total Abdominal Hysterectomy. Contraception was used in 78% and common methods were male condom (41.5%) and 36.6% used combined oral contraceptive pills. Less than half (43.9%) had follow up for 6 months and 9.8% were seen for more than a year. Eight patients had subsequent pregnancies and there was one death in the series giving a case fatality of 2.4%. Gestational trophoblastic disease is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.

Sociodemographic and clinicopathologic characteristics of 249 elderly cancer patients seen at the Radiotherapy and Oncology Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background: The rate of cancer incidence is expected to rise in the ageing population. The objective of this study is to evaluate the sociodemographic and clinicopathologic characteristics of elderly cancer patients as there is a paucity of data in this environment. Patients and Methods: Elderly cancer patients seen between 2006 and 2009 were studied retrospectively. The patients folders were reviewed for relevant clinical information using standardized structured pro forma. Data were analyzed and results were presented in a table. Results: A total of 249 patients were analyzed (mean age 67 years, M:F = 2:3). There is no formal education in 70.7% of the patients. Only 20.5% of the patients had history of alcohol ingestion and 14.1% smoke cigarette. Ten (4%) patients had family history of cancer and 1.2% was seropositive for HIV antibodies. The most common cancer in males was head and neck cancer (14.1%) followed by prostate cancer (10%). In the females, the most common cancer was cervical cancer (31.3%) followed by breast cancer (12.4%). Only 8.4% of the patients presented with early stage disease. Hypertension was the most common comorbidity seen in 35.3% of the patients followed by diabetes mellitus (7.6%). The surgery was done in 36.9% of the patients, while 63.5% of the patients had diverse chemotherapy and 42.2% had radiotherapy. Chemotherapy-induced morbidity and mortality were seen in 36.9% and 26.9% of the patients, respectively. Similarly, radiotherapy-induced morbidity and mortality were seen in 8.8% and 0.4% of the patients, respectively. Conclusion: More female elderly patients are seen. Cervical cancer and head and neck cancers are the most common cancers seen in elderly female and male patients, respectively. Most patients presented with advanced disease, and hypertension is the most common comorbidity. There should be a cautious use of chemotherapy in order to reduce mortality.

Ultrasound-guided percutaneous drainage of pyometra in cervical cancer patients on radiotherapy

Background: Pyometra is a gynecological emergency in cervical cancer patients receiving radiotherapy because it can be complicated by perforation, sepsis, and death. It can delay initiation and continuation of treatment. For certain select patients who may not be able to undergo drainage of the lesion under anesthesia via cervical dilatation and drainage, ultrasound-guided percutaneous drainage is a good alternative. We report the successes recorded in using an alternative route for pyometra drainage in cervical cancer patients on radiotherapy when the conventional examination under anesthesia and cervical drainage was not possible. Patients and Methods: Following institutional ethical approval, a prospective study was conducted from January 2014 to January 2016 on selected patients referred from the radio-oncology unit of Ahmadu Bello University Teaching Hospital, Zaria to the Gynecologic Oncology Unit with pyometra complicating advanced cervical cancer on radiotherapy. Initial attempts at cervical dilatation and drainage under anesthesia were unsuccessful necessitating this approach of percutaneous drainage under ultrasound guidance with mild sedation after obtaining informed consent. Results: Six patients were managed with a mean age of 58.5 years, who were diagnosed with advanced cervical cancers clinical stages 2B to 3A on radiotherapy. An average of 200 ml of pus was drained, and culture revealed mixed infections with predominant anaerobes strongly sensitive to metronidazole. There was recurrence in 1 case (16.7%) after 1 month of follow-up requiring a repeat procedure. Conclusion: The procedure is relatively cheap, safe, and effective in selected patients.

Schistosomiasis and second trimester tubal pregnancy in a multiparous female: A report and review of its pathology

Schistosomiasis remains a burden in sub-Saharan countries and detection is often incidental in females. Also, there is an increase in the incidence of tubal ectopic pregnancy due to pelvic inflammatory diseases (PIDs). The coexistence of these two pathologies in the female reproductive organs may lead to impaired fertility. We present a 28-year-old gravida 7, para 4 + 2 female with 2-months amenorrhea, 6 days lower abdominal pain, and 2-h history of dizzy spells seen at the Accident and Emergency Unit of our hospital. Clinical examination and ultrasound findings confirmed a ruptured right tubal gestation. She had salpingectomy and specimen was sent to the histopathology laboratory for analysis. Grossly, a well-formed male fetus consistent with 4-lunar-month gestation was seen in the expanded fallopian tube. Histopathologic sections from the tube revealed a ruptured expanded wall containing chorionic villi, decidua, and numerous Schistosoma haematobium ova. There was extensive fibrosis of the tubal wall. The diagnosis of schistosomiasis in reproductive age females is often incidental due to either absent or nonspecific symptoms, while tubal ectopic gestation is common and there are many factors attributable to its rising global incidence. Both schistosomiasis and ectopic gestation are strongly associated with infertility. Thus, the occurrence of schistosomiasis and second trimester tubal pregnancy in the same location in a multiparous female is a novelty.

Age distribution, site of origin and HIV status of cases of gynaecological malignancies seen at a radiotherapy facility in Northern Nigeria

Background: Gynecological malignancies are very common in Northern Nigeria. Although cervical cancer has been classified as HIV-related malignancy, little information is available on the pattern of presentation of gynecological malignancies in HIV patients. The objective of this study was to analyze the age distribution, site of origin, stage, and HIV status of cases of gynecological malignancies seen at a radiotherapy facility in Northern Nigeria. Patients and Methods: Between January 2006 and December 2011, consecutive patients with histologically confirmed gynecological malignancies were studied retrospectively and evaluated with respect to age, site of tumor, histological type, stage of disease, and retroviral status. Patients′ folders were reviewed using a standardized structured proforma. Results were analyzed using Epi Info software 3.4.1, 2007 edition. Results: A total of 350 gynecological malignant cases were reviewed. The age range was 21-86 years, with a mean age of 49 years, a modal age group of 41-50 years, and a median age of 50 years. The commonest gynecological malignancy observed was cervical cancer (81.7%), followed by ovarian epithelial cancer (6%), endometrial cancer (4%), ovarian germ cell tumor (3.14%), vaginal cancer (2.3%), vulvar cancer (2.3%), and myometrial sarcoma (0.6%). In all, 85.1% patients had locally advanced disease, 9.4% had metastatic disease, and 5.4% had early stage disease at presentation. HIV seropositivity was 10.3%; however, 94.4% of those with HIV had cancer of the cervix. Conclusion: In this review, the peak modal age group for gynecological malignancies is the fifth decade of life. Cervical cancer is the commonest gynecological malignancy seen with preponderance of late stages of the disease at presentation. HIV seropositivity is highest among women with cervical cancer than among women with other cancers, as seen in the facility.

The burden of gynecological cancer management in Northern Nigeria

Background: Carcinoma of the Cervix is one of the gynecologic cancers. Gynecological cancer is a scourge in the developing nations because of the burden of cervical cancer. Carcinoma of the cervix is the leading cause of cancer death in women. The costs of treatment of cancers generally are very high and this has made care very difficult in the developing nations. The question therefore is who bears the cost and whose responsibilities? Aims and Objective: To study the economic burden of cancers on the patient, and how they source for these funds. To determine how the lack of funds or otherwise has affected their care. To assess their perception of who should bear the cost of this care. Methodology: It is a prospective study of all consecutive patients that attended the Gynecologic clinic of our unit between 2nd January 2010 and 30th June 2010. Data were analyzed using Excel statistical package. Result: A total of 93 patients were interviewed. A majority of 70 (76%) of the patients had Carcinoma of the cervix. The mean age of there husbands was 58 years. Most of them were either farmers (21%) or retired civil/public servants (15%) and earn between 700 - 1700 dollars per year. A large group of the patients were full time House wives (48%), while Petty trading and farming account for 13.3% each. The women earn less than 500 dollars per year. Only 50% received assistance, from family members (35.8%) or relatives (29.6%). More than 50% of them have spent between 1000 - 3000 dollars for their health bills. It was sad to note that 40% of them have no hope of help/assistance from anywhere. A majority of 83.3% believe that the government should come to their aids. Conclusion: In the developing nations, poverty still remains major problem, where people still earn less than a dollar per day. In essence prevention is paramount; otherwise most of our women who escaped maternal mortality may end up being a victim of cancer death.

Cancer pain and management: Providers' perspective in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background: Pain is a frequent disturbing symptom of cancer, the prevalence and severity of which depend on the primary tumor, its metastatic sites, and the disease stage. The place of pain management in cancer patients cannot be over emphasized. Proper management results in improved quality of life. Aims: To assess providers′ attitude and practice toward cancer pain management in Ahmadu Bello University (ABU) Teaching Hospital, Zaria, Nigeria. Materials and Methods: This was a cross-sectional descriptive pilot study on provider perspectives on pain management in cancer patients. A structured self-administered questionnaire was completed by 79 medical practitioners of various specialties and ranks. Results: Seventy-nine clinicians were recruited for the study. The majority of the respondents, 36 (46%), believe that pain was the commonest symptom in cancer patients. Most, 61 (78%), of the doctors assessed pain using subjective methods and only 30 (29%) of the respondents were conversant with other treatment options for pain. Fifty (64.3%) use analgesia, and their choices were guided mainly by the response of the patients. Forty-eight (61.5%) of those who admit to the use of analgesia, were actually limited by the side effects of the drugs. More than half (57.6%) believed that pain management in our settings is suboptimal, and the commonest limitation to optimal pain management in our settings was availability and affordability of drugs. Conclusion: Professional education needs to focus on the proper assessment of pain, the management of side effects of analgesics, and the use of adjuvant therapies for pain. A better understanding of the pharmacology of opioid analgesics is also needed.