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

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.

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.

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.

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