Dying Undiagnosed: Challenges of Management of Ovarian Tumours in a Resource-Poor Setting in North-western Nigeria

Background: Ovarian cancer is the second most prevalent but most lethal gynaecologic malignancy in our institution. This study aimed at determining the rate of non-diagnosis in suspected lesions and reviewing the management challenges of ovarian tumours highly suspicious for malignancy in our hospital.

Methodology: A three-year retrospective review of patients’ records from the ward, clinic, theatre, and histopathology laboratory was carried out. Cases with high indices of suspicion for ovarian cancer (ovarian tumour with malignant radiologic features with any of ascites, pleural effusion, cachexia, anaemia, or evidence of metastasis) were included. In-depth interviews were carried out with a consultant from each speciality of Radiology, Radio-oncology, Pathology and Gynaecologic oncology at the gynaecologic oncology multidisciplinary team meeting.

Results: 122 cases of highly suspicious ovarian malignancies were seen with a mean age of 40.6 years. Of these, 28 (23%) had surgery and 77% had no histological diagnosis. Of those that had surgery, 13 (46.4%) had upfront surgery and 15 (53.6%) neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Only two cases had documented complete (R0) debulking. Among those that had upfront surgery, one case (7.7%) was an ovarian fibroid and one (7.7%) was a fibrosarcoma while two cases (15.4%) were borderline ovarian tumours. In three cases, chemotherapy was commenced based on malignant cells on ascitic or pleural fluid cytology. Of all the malignant cases, epithelial carcinomas were the most common accounting for 48%.

Conclusion: Most patients with tumours highly suspicious of ovarian cancers did not get a histologic diagnosis and probably died undiagnosed. Management of ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. Health insurance for all, infrastructure development and training of all disciplines involved is recommended.