- A-Z Publications
- Southern African Journal of Gynaecological Oncology
- Previous Issues
- Volume 5, Issue 1, 2013
Southern African Journal of Gynaecological Oncology - Volume 5, Issue 1, 2013
Volume 5, Issue 1, 2013
Author Greta DreyerSource: Southern African Journal of Gynaecological Oncology 5 (2013)More Less
Cervical cancer remains a major public and women's health problem both in our region and worldwide. In gynaecologic oncology it is both the most preventable and sadly the most prevalent malignancy in our tertiary hospitals and oncology units. It is therefore very appropriate and no surprise that much local research focuses on the prevention and treatment of this disease. In the current issue we publish four original research reports, three of these on the prevention, diagnosis and staging of cervical cancer.
Cervical cancer screening programme in Limpopo province : January 2007 to December 2010 : original researchSource: Southern African Journal of Gynaecological Oncology 5, pp 4 –10 (2013)More Less
Objective: South Africa launched a cervical screening policy in 2001 and aimed to screen 70% of women aged 30 years and older by the year 2010. The current study describes the performance of the cervical cancer screening programme that was implemented in the Limpopo province between 2007 and 2010.
Design: A retrospective descriptive analysis of data on cervical smears that were collected and evaluated by the National Health Laboratory Services in the Limpopo province from 2007 to 2010.
Outcome measures: Screening coverage, smear adequacy, appropriate age for screening and prevalence of premalignancy were calculated.
Results: Overall, 202 251 cervical smears were submitted in the Limpopo province between 2007 and 2010. The number of smears increased from 39 029 in 2007 to 63 512 in 2010. Of the 202 251 women screened, 130 911 (72.7%) were within the recommended screening age (30 years and older). Annual screening coverage rates ranged from 2.9-4.2% of the population of women aged 30 years and older. The cumulative screening coverage during the four years was 13.7%. The mean smear adequacy rate during this time was 98.5%. Of the 202 251 smears, 5 237 (2.5%) reflected high-grade squamous intraepithelial lesions, while 238 (0.2%) contained malignant lesions.
Conclusion: The cervical cancer screening programme in Limpopo improved during the study period, but still fell short of national goals. Key areas that require strengthening include low screening coverage and the screening of young women who are at less risk of acquiring cervical cancer
A retrospective analysis comparing clinical staging with magnetic resonance imaging staging in patients with cervical cancer : original researchSource: Southern African Journal of Gynaecological Oncology 5, pp 11 –15 (2013)More Less
This single-institution retrospective study compares the accuracy of clinical and magnetic resonance imaging (MRI) staging of cervical cancer. For patients who underwent surgery, MRI and clinical staging were compared to final pathological stage. Pathological stage was utilised as the reference standard.
One hundred and twenty-eight patients underwent MRI and 45 proceeded to surgery. There was concurrence between MRI staging and pathological stage in only 29.3% of patients. MRI overestimated staging in 53.6% of the patients, and underestimated staging in 17.1%. The comparison between clinical staging and pathological stage indicated concurrences in 43.9% of the patients. Stage was overestimated in 19.5% and was underestimated in 36.6%. There was no statistically significant difference between the two staging options.
Reasons why unscreened patients with cervical cancer present with advanced stage disease : original researchSource: Southern African Journal of Gynaecological Oncology 5, pp 16 –20 (2013)More Less
Objective: Cervical cancer is the most common gynaecological cancer in South Africa, and the vast majority of women present with an advanced stage of the disease. This can be attributed to the absence of an implemented screening programme, resulting in patients becoming symptomatic prior to diagnosis. There are little data on the health-seeking behaviour of these women. The objective was to investigate the circumstances of patients who present with cervical cancer, as well as examine their presenting symptoms and behaviour following the onset of symptoms.
Design: Descriptive study. Data were collected from patients who were diagnosed with cervical cancer by means interviews and a questionnaire.
Setting and subjects: Women diagnosed and managed with cervical cancer at the Gynaecological Oncology Unit, Kalafong Hospital, Pretoria.
Outcomes measured: Included demographic data, tumour characteristics, presenting symptoms, number of visits to and interventions performed at the primary healthcare contact.
Results: Eighty-five patients were recruited. Of these, 74% lived in rural areas, 81% had access to primary healthcare facilities and 83% lived close to a healthcare provider. Eight had early-stage disease. The most common presenting symptoms were vaginal bleeding, pain and vaginal discharge. After the onset of symptoms, 55% of patients visited their healthcare provider within four weeks. At the first visit, only 41% of patients had a gynaecological examination and only 15% were appropriately referred, compared to 23% at their second visit. Late presentation was significantly associated with no gynaecological examination (p-value < 0.01).
Conclusion: The lack of a cervical cancer screening programme, suboptimal management of symptomatic patients and low levels of literacy and knowledge about cervical cancer and screening are compounding the plight of these patients.
The types and treatment outcomes of germ cell tumours of the ovary seen at Groote Schuur Hospital, Cape Town,between 1994 and 2008: a retrospective survey : original researchSource: Southern African Journal of Gynaecological Oncology 5, pp 21 –28 (2013)More Less
Objective: This retrospective observational study aims to review patients with malignant ovarian germ cell tumours (MOGCTs) treated at Groote Schuur Hospital over a 15-year period.
Method: A medical chart review of adult patients with MOGCTs treated between 1994 and 2008 was conducted. Gathered data were transferred to an electronic spreadsheet. The Kaplan-Meier method was used to obtain five year survival data.
Results: Forty patients were treated for MOGCTs. Median age at the time of diagnosis was 30.2 years (a range of 13-63 years). Ten patients (25%) had dysgerminoma and 30 (75%) had non-dysgerminomatous types. The latter group comprised immature teratoma (10 patients), yolk sac tumour (8), mixed germ cell tumour (3), and mature teratoma with malignant transformation (MTMT) (9). Standard staging surgery was performed with fertility sparing procedures wherever possible. Chemotherapy entailed a three-day modified bleomycin/etoposide/cisplatinum (BEP) regimen during the study period. Excluding the group of nine with monodermal malignant transformation in mature teratoma, complete response to primary treatment was achieved in 24 of 31 patients (77.4%). After a median follow-up of 42.5 months (a range of 2-60), the overall five-year survival rate was 69.1%. The overall five-year survival rate was only 40% in five human immunodeficiency virus (HIV)-positive patients. Four of the nine patients with MTMT were alive after five years.
Conclusion: The prognosis of MOGCTs is excellent if managed with standard treatment initially. Treatment of MTMT is less well defined. Patients with advanced HIV infection did poorly and should be considered for initiation of antiretroviral therapy prior to chemotherapy.
Chronic inflammatory demyelinating polyneuropathy,diagnosed as a paraneoplastic manifestation of small cell neuroendocrine carcinoma of the cervix : case studySource: Southern African Journal of Gynaecological Oncology 5, pp 29 –32 (2013)More Less
Paraneoplastic syndrome frequently presents before cancer is diagnosed and can be associated with neoplastic disease that is not yet radiographically detectable. We report on the case of a 35-year-old woman who presented at the neurology department with complaints of insidious onset and gradually progressive weakness in all four limbs, which had lasted for the past six months. The weakness originally commenced in both lower limbs and was progressive, ascending in nature from distal to proximal. Both upper limbs were affected seven days later. Magnetic resonance imaging of the dorsal spine revealed long-segment T2 and short T1 inversion recovery (STIR) hyperintensity, suggestive of myelitis. Nerve conduction studies and an electromyogram suggested sensory motor polyneuropathy which affected all four limbs. On gynaecological check-up, a diagnosis of International Federation of Gynaecology and Obstetrics (FIGO) stage IIB carcinoma cervix was made. Histology diagnosed it as a case of small cell neuroendocrine carcinoma. Thus, a diagnosis of chronic inflammatory demyelinating polyneuropathy, arising as a paraneoplastic syndrome in the carcinoma cervix, was made. The patient was treated with chemotherapy, steroids and radical radiotherapy. She recovered partially from her motor deficiencies and completely from her sensory derangement, and was devoid of gynaecological complaints. The cancer growth regressed completely.
Management with fertility preservation of an ovarian juvenile granulosa cell tumour presenting with retroperitoneal spread and bilateral ureteric obstruction : case studySource: Southern African Journal of Gynaecological Oncology 5, pp 33 –35 (2013)More Less
Metastatic and recurrent ovarian juvenile granulosa cell tumours in young women are an uncommon condition. Primary management in young patients includes surgery with subsequent chemotherapy in selected cases. Fertility-preservation surgery may be possible, while still achieving appropriate cytoreduction and staging procedures. Retroperitoneal spread to lymph nodes is rare and lymphadenectomy is not routinely recommended. Recurrent disease or persistent disease may require further surgery and once again, it may be possible to preserve fertility without compromising oncological outcome.