The pattern and management of ovarian cancer at Muhimbili National Hospital, Dar Es Salaam, Tanzania

Abstract

ABSTRACT Ovarian cancer is one of the most common gynecological malignancies of the female reproductive tract and has a very poor prognosis. Globally the five year survival is only 15 to 20 percent in patient with clinically advanced disease. The sign and symptoms are often vague, and as such many patients present with the disease when they are already in late stages. When diagnosed early, survival is far better. The treatment is optimal debugging which is followed by chemotherapy depending on the extent of spread of the cancer. At Muhimbili National Hospital, majority of ovarian cancer patients are presenting with advanced stage disease and many of the women delay to commence chemotherapy after surgery. Objective: the aim of this study was to determine the pattern of ovarian cancer patients admitted at MNH and their management. Methodology: This was a retrospective descriptive study of ovarian cancer cases over a five years period (2012-2016) admitted and treated at Muhimbili National Hospital, the largest tertiary referral hospital in Dar es Salaam. The source of data was patients’ files, medical records retrieved from the Central Pathology Laboratory, admission books, operating theatres, and the gynecology ward round book. Data was collected using a standardized checklist for all cases with confirmed histology and information was obtained from the case file which included socio-demographic profile, parity, histological type of cancer, clinical presentation, treatment options and outcome. Thereafter, the case records were followed up at the Ocean Road Cancer Institute, where these patients are referred for chemotherapy after cytoreduction at Muhimbili National Hospital. Other patient information such as the onset and type of chemotherapy that was given and the outcome were obtained at the Ocean Road Cancer Institute. The data was entered into Statistical Package for Social Sciences SPSS ver. 23, and presented by frequency tables, proportions and absolute counts. Results: Of the total number of 3,401 gynecological cancers admission, ovarian cancers constituted 8.03% of all gynecological cancers admitted and treated at the MNH. Epithelial ovarian cancer constituted 83.1%, while germ cell and sex cord stromal accounted for 4.7% and 3.5% respectively. Serous epithelial cancers accounted for 43.6%, while mucinous epithelium cancer accounted for 21.5%. About Eighty-five percent of patient presented with advanced stages of the disease, with median age of 50 years. Nulliparous women accounted for 22.1% of the cases. The number of women receiving chemotherapy after cytoreduction was 40.9%, and the average number of days from cytoreduction to chemotherapy was 45.1 days (SD 24.8). About Seventeen percent of women were discharged stable after treatment and 33.6% of patients were counsel for palliative care while 18.1% of the women succumb during treatment at both MNH and ORCI.

Conclusion Majority of women presented to hospital with advanced stage epithelial ovarian cancer. The main stay of treatment was surgery and chemotherapy, and majority of women delayed in starting chemotherapy after surgery.