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The Challenges of Managing Ovarian Cancer in the Developing World

The Challenges of Managing Ovarian Cancer in the Developing World Hindawi Case Reports in Oncological Medicine Volume 2020, Article ID 8379628, 4 pages https://doi.org/10.1155/2020/8379628 Case Report The Challenges of Managing Ovarian Cancer in the Developing World 1 2,3 1 1 Olivier Mulisya , Franck K. Sikakulya , Mbusa Mastaki, Tambavira Gertrude, and Mathe Jeff Department of Obstetrics and Gynecology, FEPSI Hospital, Butembo, Congo Department of Surgery, Kampala International University Western Campus, Ishaka, Uganda Faculty of Medicine, Université Catholique du Graben, Butembo, Congo Department of Obstetrics and Gynecology, Université Catholique du Graben, Butembo, Congo Correspondence should be addressed to Olivier Mulisya; omulisya1@gmail.com Received 10 July 2019; Accepted 21 February 2020; Published 11 March 2020 Academic Editor: Jose I. Mayordomo Copyright © 2020 Olivier Mulisya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ovarian cancer has high morbidity and mortality rates among cancers of the reproductive system. The disease typically presents at late stage when the 5-year relative survival rate is only 29%. Similarly, access to prevention, early diagnosis, treatment, and palliative care for cancer-related disease is insufficient. The availability of cancer treatments in Africa is especially poor. Case. A 17-year-old lady, nulliparous, was admitted with complaint of abdominal swelling and loss of weight and a huge left ovarian cyst revealed by ultrasound scan. Laparotomy was done, and a mass which resembled a hemorrhagic solid tumor was found. Grossly, the left ovarian mass measured 15:0×20:0×8:0 cm and a left salpingectomy was performed. Two months later, she came back with lower limb swelling progressively increased in a week with vulvar edema, with a palpable mass. She was discharged on request by her relatives for traditional medicine. One year later, she passed on in an unrevealed picture. The management of ovarian cancer is too challenging in low-resource countries, from hospital settings to the communities with poor cancer awareness. It is therefore imperative that healthcare resources, policies, and planning focus to be coordinated in a rational way. 1. Introduction Ovarian cancer has a usually relatively poor prognosis; it is disproportionately deadly because it lacks early detection or screening tests implying that most cases are not diagnosed Ovarian cancer is recognized as the most leading cause of death among gynecology cancers with a yearly incidence of until they have reached late stages. Possible molecular 239,000 new cases and 152,000 deaths worldwide [1]. Late markers including microRNAs, methylation markers, ultra- diagnosis is the main cause of this mortality [2]. sonography, and computed sonography may facilitate early Ovarian cancer has high morbidity and mortality rates diagnosis [5]. among cancers of the reproductive system. According to In about 10% of cases, ovarian cancer tends to occur global estimates, 225,000 new cases were detected each year, spontaneously. The key to controlling ovarian cancer appears and 140,000 people annually die from the disease [3]. to be early detection and treatment at the very early stages In Africa, studies have shown that ovarian cancer is the when cure may be theoretically possible [6]. second most common gynecological cancer in developing The global focus to combat cancer needs to be on cancer countries [4]. A woman’s lifetime risk of developing ovarian awareness, early detection, diagnosis, and availability and cancer is 1 in 75, and her chance of dying of the disease is 1 in affordability of treatment in all cancers [5]. 100. The disease typically presents at late stage when the 5- The clinic presentation of ovarian cancer has nonspecific year relative survival rate is only 29% [1]. symptoms and this lead to its late diagnosis in an advance 2 Case Reports in Oncological Medicine The abdomen was not distended, but with palpable mass, stage using random abdomen ultrasound scan or laparos- copy [7]. firm and tender in the hypogastrium. Provision of cancer care is a multidisciplinary effort that The vulva was edematous with lower limb swelling. necessitates both anatomical pathology and clinical labora- The laboratory tests revealed: tory services. In many parts of sub-Saharan Africa, some oncology services have functioned without the necessary (i) Urea: 60.95 mg/dl, creatinine: 10.5 mg/dl (ten times higher than the normal range) pathology-based diagnosis or laboratory tests that should be offered by pathology departments [8]. (ii) Serum hCG was negative Similarly, access to prevention, early diagnosis, treat- ment, and palliative care for cancer-related disease is insuffi- (iii) Hemoglobin: 10.4 g/dl cient. The availability of cancer treatments in Africa is (iv) WBCs: 3,700 especially poor [9]. In view of the insufficient attention paid historically to The ultrasound scan revealed a mass of 11:6×9:6 cm in cancer in Africa, the number of cancer specialists as a pro- the hypogastrium with bilateral hydronephrosis. portion of all healthcare workers is probably low [9]. The diagnosis of metastatic ovarian cancer was made Additionally, insufficient resources for pathology lead to with renal failure. inadequate workforce, poor facilities and equipment, and She was given IV hydrocortisone 200 mg three times a low availability of immunohistology [8]. day with 2.5 l of normal saline and IV lasix 80 mg. The urine We are reporting the case of ovarian cancer in a 17-year- output was monitored, and oliguria was noticed despite the old lady for the purpose of showing the challenge in the man- dose of lasix. agement of cancers in general and especially ovarian cancer She was given IV ceftriaxone 1 g two times a day and IM in low settings, in the Eastern DR Congo. diclofenac 75 mg two times a day. The patient did not improve and had persistent abdom- 2. Case Report inal pain, lower limb swelling, and oliguria despite the kid- ney challenge and her treatment. On day 8, her relatives A 17-year-old lady, nulliparous, was admitted in the gyneco- requested for her to be discharged for further management logical ward with complaint of abdominal swelling and loss in Beni which is close to their home. of weight. Her menstrual history was unremarkable. On Later on, we heard that the patient was given some tradi- examination, a palpable abdominopelvic mass was detected; tional medicine, and the patient improved well and went the ultrasound scan revealed a left ovarian cyst (15 × 17 cm), back to a training center where she was learning hairstyle. no free fluid was seen, the rest of her abdominopelvic sono- For a year, she was doing somehow with progressive weight graphic examination was normal, and the initial clinical loss as reported by her relatives. diagnosis was one of left ovarian cyst. Her Hb was 10.3 g%; On a bad note, we heard that she was taken to the general the urinalysis, HIV test, hepatitis, and beta hCG were unre- hospital and was managed as an outpatient but passed on two markable. A laparotomy was planned three days later, and days after the check up in an unrevealed picture. perioperatively, the mass resembled a hemorrhagic solid tumor as shown in Figure 1. Grossly, the left ovarian mass measured 15:0×20:0×8:0 cm and was brownish and hem- 3. Discussion orrhagic, with solid and cystic areas, irregular surface with adhesions of the colon to the mass, and no ascites. The right We presented a case of a 17-year-old lady who died within tube and ovary appeared normal with a grossly normal one year of presenting with recurrent abdominopelvic mass uterus, and a left salpingo-oophorectomy was performed associated with weight loss. The clinical findings as well as and hemostasis achieved. She was given one unit of blood. histology let us believe that this could be a case of ovarian The specimen was sent to the laboratory for histology and malignancy. the result came out after 24 days and revealed diffuse lym- In this report, we described a case of ovarian cancer phoma with largest cells vs. carcinoid tumor with require- which was difficult to confirm without immunohistochemis- ments of doing immunohistochemistry (Figure 2). Her try and to direct the proper management. It is very clear that postoperative findings were unremarkable, and she was dis- this patient needed adjuvant chemotherapy immediately th charged on her 6 postoperative day. after the first surgery and probably radiotherapy but these She came for review a month later without any com- could not be available despite the final diagnosis. There is a high incidence and mortality from gyneco- plaint, her hemoglobin was 13.2 g%. Two months later, she came back again with lower limb swelling progressively logical cancers in developing countries due primarily to increased in a week as shown in Figure 3. She has received the failure of these countries to mount effective nationally ibuprofen and cloxacilline as an outpatient unsuccessfully. organized screening programs. A huge unmet need for Her last menstrual period was 21 days back. funding for cancer care and control exists in low-resource countries [6]. Hospitals in Butembo have no pathology On examination, she was in a fair general condition, alert, afebrile on touch, no pallor, no jaundice with general edema, department; specimens are sent to the capital city, 2000+ and no palpable lymph nodes. Her weight was 42 kgs. Her miles through the Université Catholique du Graben’s labo- blood pressure was 90/60 mmHg. ratory for reading; CA125 tests are not available and not Case Reports in Oncological Medicine 3 Figure 1: Ovarian tumor resected. other phenotypic and genotypic characteristics that affect prognosis and guide treatment) and on the availability of tests that can be used to follow response to treatment and to detect tumor recurrence [8]. One of the main reasons for the high cancer mortality in sub-Saharan Africa is poor public knowledge and awareness about cancer. Cancer awareness is especially important to improve risk reduction behaviors, promote timely cancer screening for early detection, and ultimately reduce the cancer burden in sub-Saharan Africa [9]. The patient in this case report was taken for prayers and traditional medicine because most people still believe in witchcraft for some dis- eases quite challenging like cancers. Figure 2: Pathology laboratory results. The main factors causing low cancer awareness in sub- Saharan Africa are the political environment, the eco- nomic situation (including funding support), societal norms, cultural beliefs, and values [9]. All investigations are not affordable from histology to treatment of cancers in the region. For our case, the relatives could not afford the 250 (USD) requested for immunohistochemistry. And even for chemotherapy or radiotherapy, they would have had to cross the border to the nearest country Uganda for further management. During surgery, only inspection, adhesiolysis, and uni- lateral salpingo-oophorectomy was done, yet according to Schorge et al. [10], peritoneal washings should be collected immediately upon entering into the abdomen, followed by Figure 3: Lower limb and vulva swelling. exploration. The ovarian mass should be removed intact and submitted to pathology for frozen section evaluation. affordable. There is no cancer unit around. There is no oncol- However, it is almost impossible to know with certainty ogist in all regions. Besides all these, chemotherapy is also not whether a patient has a benign adnexal mass, low malig- available. And radiotherapy is nowhere to be seen in the nant potential tumor, or invasive ovarian cancer until final whole country. histologic slides have been reviewed. In those with low The management of cancer requires a specialist’s knowl- malignant potential tumors diagnosed intraoperatively, lim- edge; there is a paucity of all types of specialists (oncologists, ited staging biopsies of the peritoneum and omentum should be considered. Additionally, the appendix also should be pathologists, radiologists, etc.). Not only are specialist resources scarce but also are support services and essential examined and potentially removed, especially if the tumor has mucinous histology. Routine pelvic and para-aortic medications lacking in our region. Policymakers need to understand that cancer care is a lymph node dissection is also considered in the presence of comprehensive endeavor that relies on the ability to properly enlarged nodes or a frozen section suggestive of frankly inva- sive disease [10]. classify the specific type of cancer (and optimally identify 4 Case Reports in Oncological Medicine 4. Conclusion The management of ovarian cancer is too challenging in low- resource countries, from hospital settings to the communities with poor cancer awareness. It is therefore imperative that healthcare resources, poli- cies, and planning focus to be coordinated in a rational way. Advocacy and the political will to invest in the develop- ment of human resources and healthcare infrastructure appear critical to gynecological cancer control and reducing the burden of disease in our region. A strong coalition between governments, experts, commu- nities, and donor agencies will be needed to achieve these goals. Consent An informed consent was obtained from the patient relatives for this publication. Conflicts of Interest The authors declare that there is no conflict of interest regarding the publication of this paper. References [1] B. M. Reid, J. B. Permuth, and T. A. Sellers, “Epidemiology of ovarian cancer: a review,” Cancer Biology & Medicine, vol. 14, no. 1, pp. 9–32, 2017. [2] S. Mun, S.-H. Jang, and A. Ryu, “Early stage ovarian carcinoma with symptoms mimicking tuberculous peritonitis in a postmen- opausal woman,” Medicine, vol. 97, no. 40, article e12669, 2018. [3] S. Razi, M. Ghoncheh, A. Mohammadian-Hafshejani, H. Aziznejhad, M. Mohammadian, and H. Salehiniya, “The incidence and mortality of ovarian cancer and their relation- ship,” Ecancermedicalscience, vol. 10, 2016. [4] K. S. Okunade, H. Okunola, A. A. Okunowo, and R. I. Anorlu, “A five year review of ovarian cancer at a tertiary institution in Lagos, South-West, Nigeria,” Nigerian Journal of General Practice, vol. 14, no. 2, pp. 23–27, 2016. [5] D. Saranath and A. Khanna, “Current status of cancer burden: global and Indian scenario,” Biomedical Research Journal, vol. 1, no. 1, pp. 1–5, 2014. [6] C. A. Iyoke and G. O. Ugwu, “Burden of gynaecological cancers in developing countries,” World Journal of Obstetrics and Gynecology, vol. 2, no. 1, pp. 1–7, 2013. [7] E. S. Paik, J. H. Kim, T.-J. Kim et al., “Prognostic significance of normal-sized ovary in advanced serous epithelial ovarian cancer,” Journal of Gynecologic Oncology, vol. 29, no. 1, article e13, 2018. [8] A. Adesina, D. Chumba, A. M. Nelson et al., “Improvement of pathology in sub-Saharan Africa,” The Lancet Oncology, vol. 14, no. 4, pp. e152–e157, 2013. [9] I. O. Morhason-Bello, F. Odedina, T. R. Rebbeck et al., “Challenges and opportunities in cancer control in Africa: a perspective from the African Organisation for Research and Training in Cancer,” The Lancet Oncology, vol. 14, no. 4, pp. e142–e151, 2013. [10] J. O. Schorge, L. M. Halvorson, K. D. Bradshaw, J. I. Schaffer, B. L. Hoffman, and F. G. Cunningham, Ginecologia de Williams, McGraw Hill Brasil, 2011. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

The Challenges of Managing Ovarian Cancer in the Developing World

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Hindawi Publishing Corporation
Copyright
Copyright © 2020 Olivier Mulisya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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2090-6706
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2090-6714
DOI
10.1155/2020/8379628
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2020, Article ID 8379628, 4 pages https://doi.org/10.1155/2020/8379628 Case Report The Challenges of Managing Ovarian Cancer in the Developing World 1 2,3 1 1 Olivier Mulisya , Franck K. Sikakulya , Mbusa Mastaki, Tambavira Gertrude, and Mathe Jeff Department of Obstetrics and Gynecology, FEPSI Hospital, Butembo, Congo Department of Surgery, Kampala International University Western Campus, Ishaka, Uganda Faculty of Medicine, Université Catholique du Graben, Butembo, Congo Department of Obstetrics and Gynecology, Université Catholique du Graben, Butembo, Congo Correspondence should be addressed to Olivier Mulisya; omulisya1@gmail.com Received 10 July 2019; Accepted 21 February 2020; Published 11 March 2020 Academic Editor: Jose I. Mayordomo Copyright © 2020 Olivier Mulisya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ovarian cancer has high morbidity and mortality rates among cancers of the reproductive system. The disease typically presents at late stage when the 5-year relative survival rate is only 29%. Similarly, access to prevention, early diagnosis, treatment, and palliative care for cancer-related disease is insufficient. The availability of cancer treatments in Africa is especially poor. Case. A 17-year-old lady, nulliparous, was admitted with complaint of abdominal swelling and loss of weight and a huge left ovarian cyst revealed by ultrasound scan. Laparotomy was done, and a mass which resembled a hemorrhagic solid tumor was found. Grossly, the left ovarian mass measured 15:0×20:0×8:0 cm and a left salpingectomy was performed. Two months later, she came back with lower limb swelling progressively increased in a week with vulvar edema, with a palpable mass. She was discharged on request by her relatives for traditional medicine. One year later, she passed on in an unrevealed picture. The management of ovarian cancer is too challenging in low-resource countries, from hospital settings to the communities with poor cancer awareness. It is therefore imperative that healthcare resources, policies, and planning focus to be coordinated in a rational way. 1. Introduction Ovarian cancer has a usually relatively poor prognosis; it is disproportionately deadly because it lacks early detection or screening tests implying that most cases are not diagnosed Ovarian cancer is recognized as the most leading cause of death among gynecology cancers with a yearly incidence of until they have reached late stages. Possible molecular 239,000 new cases and 152,000 deaths worldwide [1]. Late markers including microRNAs, methylation markers, ultra- diagnosis is the main cause of this mortality [2]. sonography, and computed sonography may facilitate early Ovarian cancer has high morbidity and mortality rates diagnosis [5]. among cancers of the reproductive system. According to In about 10% of cases, ovarian cancer tends to occur global estimates, 225,000 new cases were detected each year, spontaneously. The key to controlling ovarian cancer appears and 140,000 people annually die from the disease [3]. to be early detection and treatment at the very early stages In Africa, studies have shown that ovarian cancer is the when cure may be theoretically possible [6]. second most common gynecological cancer in developing The global focus to combat cancer needs to be on cancer countries [4]. A woman’s lifetime risk of developing ovarian awareness, early detection, diagnosis, and availability and cancer is 1 in 75, and her chance of dying of the disease is 1 in affordability of treatment in all cancers [5]. 100. The disease typically presents at late stage when the 5- The clinic presentation of ovarian cancer has nonspecific year relative survival rate is only 29% [1]. symptoms and this lead to its late diagnosis in an advance 2 Case Reports in Oncological Medicine The abdomen was not distended, but with palpable mass, stage using random abdomen ultrasound scan or laparos- copy [7]. firm and tender in the hypogastrium. Provision of cancer care is a multidisciplinary effort that The vulva was edematous with lower limb swelling. necessitates both anatomical pathology and clinical labora- The laboratory tests revealed: tory services. In many parts of sub-Saharan Africa, some oncology services have functioned without the necessary (i) Urea: 60.95 mg/dl, creatinine: 10.5 mg/dl (ten times higher than the normal range) pathology-based diagnosis or laboratory tests that should be offered by pathology departments [8]. (ii) Serum hCG was negative Similarly, access to prevention, early diagnosis, treat- ment, and palliative care for cancer-related disease is insuffi- (iii) Hemoglobin: 10.4 g/dl cient. The availability of cancer treatments in Africa is (iv) WBCs: 3,700 especially poor [9]. In view of the insufficient attention paid historically to The ultrasound scan revealed a mass of 11:6×9:6 cm in cancer in Africa, the number of cancer specialists as a pro- the hypogastrium with bilateral hydronephrosis. portion of all healthcare workers is probably low [9]. The diagnosis of metastatic ovarian cancer was made Additionally, insufficient resources for pathology lead to with renal failure. inadequate workforce, poor facilities and equipment, and She was given IV hydrocortisone 200 mg three times a low availability of immunohistology [8]. day with 2.5 l of normal saline and IV lasix 80 mg. The urine We are reporting the case of ovarian cancer in a 17-year- output was monitored, and oliguria was noticed despite the old lady for the purpose of showing the challenge in the man- dose of lasix. agement of cancers in general and especially ovarian cancer She was given IV ceftriaxone 1 g two times a day and IM in low settings, in the Eastern DR Congo. diclofenac 75 mg two times a day. The patient did not improve and had persistent abdom- 2. Case Report inal pain, lower limb swelling, and oliguria despite the kid- ney challenge and her treatment. On day 8, her relatives A 17-year-old lady, nulliparous, was admitted in the gyneco- requested for her to be discharged for further management logical ward with complaint of abdominal swelling and loss in Beni which is close to their home. of weight. Her menstrual history was unremarkable. On Later on, we heard that the patient was given some tradi- examination, a palpable abdominopelvic mass was detected; tional medicine, and the patient improved well and went the ultrasound scan revealed a left ovarian cyst (15 × 17 cm), back to a training center where she was learning hairstyle. no free fluid was seen, the rest of her abdominopelvic sono- For a year, she was doing somehow with progressive weight graphic examination was normal, and the initial clinical loss as reported by her relatives. diagnosis was one of left ovarian cyst. Her Hb was 10.3 g%; On a bad note, we heard that she was taken to the general the urinalysis, HIV test, hepatitis, and beta hCG were unre- hospital and was managed as an outpatient but passed on two markable. A laparotomy was planned three days later, and days after the check up in an unrevealed picture. perioperatively, the mass resembled a hemorrhagic solid tumor as shown in Figure 1. Grossly, the left ovarian mass measured 15:0×20:0×8:0 cm and was brownish and hem- 3. Discussion orrhagic, with solid and cystic areas, irregular surface with adhesions of the colon to the mass, and no ascites. The right We presented a case of a 17-year-old lady who died within tube and ovary appeared normal with a grossly normal one year of presenting with recurrent abdominopelvic mass uterus, and a left salpingo-oophorectomy was performed associated with weight loss. The clinical findings as well as and hemostasis achieved. She was given one unit of blood. histology let us believe that this could be a case of ovarian The specimen was sent to the laboratory for histology and malignancy. the result came out after 24 days and revealed diffuse lym- In this report, we described a case of ovarian cancer phoma with largest cells vs. carcinoid tumor with require- which was difficult to confirm without immunohistochemis- ments of doing immunohistochemistry (Figure 2). Her try and to direct the proper management. It is very clear that postoperative findings were unremarkable, and she was dis- this patient needed adjuvant chemotherapy immediately th charged on her 6 postoperative day. after the first surgery and probably radiotherapy but these She came for review a month later without any com- could not be available despite the final diagnosis. There is a high incidence and mortality from gyneco- plaint, her hemoglobin was 13.2 g%. Two months later, she came back again with lower limb swelling progressively logical cancers in developing countries due primarily to increased in a week as shown in Figure 3. She has received the failure of these countries to mount effective nationally ibuprofen and cloxacilline as an outpatient unsuccessfully. organized screening programs. A huge unmet need for Her last menstrual period was 21 days back. funding for cancer care and control exists in low-resource countries [6]. Hospitals in Butembo have no pathology On examination, she was in a fair general condition, alert, afebrile on touch, no pallor, no jaundice with general edema, department; specimens are sent to the capital city, 2000+ and no palpable lymph nodes. Her weight was 42 kgs. Her miles through the Université Catholique du Graben’s labo- blood pressure was 90/60 mmHg. ratory for reading; CA125 tests are not available and not Case Reports in Oncological Medicine 3 Figure 1: Ovarian tumor resected. other phenotypic and genotypic characteristics that affect prognosis and guide treatment) and on the availability of tests that can be used to follow response to treatment and to detect tumor recurrence [8]. One of the main reasons for the high cancer mortality in sub-Saharan Africa is poor public knowledge and awareness about cancer. Cancer awareness is especially important to improve risk reduction behaviors, promote timely cancer screening for early detection, and ultimately reduce the cancer burden in sub-Saharan Africa [9]. The patient in this case report was taken for prayers and traditional medicine because most people still believe in witchcraft for some dis- eases quite challenging like cancers. Figure 2: Pathology laboratory results. The main factors causing low cancer awareness in sub- Saharan Africa are the political environment, the eco- nomic situation (including funding support), societal norms, cultural beliefs, and values [9]. All investigations are not affordable from histology to treatment of cancers in the region. For our case, the relatives could not afford the 250 (USD) requested for immunohistochemistry. And even for chemotherapy or radiotherapy, they would have had to cross the border to the nearest country Uganda for further management. During surgery, only inspection, adhesiolysis, and uni- lateral salpingo-oophorectomy was done, yet according to Schorge et al. [10], peritoneal washings should be collected immediately upon entering into the abdomen, followed by Figure 3: Lower limb and vulva swelling. exploration. The ovarian mass should be removed intact and submitted to pathology for frozen section evaluation. affordable. There is no cancer unit around. There is no oncol- However, it is almost impossible to know with certainty ogist in all regions. Besides all these, chemotherapy is also not whether a patient has a benign adnexal mass, low malig- available. And radiotherapy is nowhere to be seen in the nant potential tumor, or invasive ovarian cancer until final whole country. histologic slides have been reviewed. In those with low The management of cancer requires a specialist’s knowl- malignant potential tumors diagnosed intraoperatively, lim- edge; there is a paucity of all types of specialists (oncologists, ited staging biopsies of the peritoneum and omentum should be considered. Additionally, the appendix also should be pathologists, radiologists, etc.). Not only are specialist resources scarce but also are support services and essential examined and potentially removed, especially if the tumor has mucinous histology. Routine pelvic and para-aortic medications lacking in our region. Policymakers need to understand that cancer care is a lymph node dissection is also considered in the presence of comprehensive endeavor that relies on the ability to properly enlarged nodes or a frozen section suggestive of frankly inva- sive disease [10]. classify the specific type of cancer (and optimally identify 4 Case Reports in Oncological Medicine 4. Conclusion The management of ovarian cancer is too challenging in low- resource countries, from hospital settings to the communities with poor cancer awareness. It is therefore imperative that healthcare resources, poli- cies, and planning focus to be coordinated in a rational way. Advocacy and the political will to invest in the develop- ment of human resources and healthcare infrastructure appear critical to gynecological cancer control and reducing the burden of disease in our region. A strong coalition between governments, experts, commu- nities, and donor agencies will be needed to achieve these goals. Consent An informed consent was obtained from the patient relatives for this publication. Conflicts of Interest The authors declare that there is no conflict of interest regarding the publication of this paper. References [1] B. M. Reid, J. B. Permuth, and T. A. Sellers, “Epidemiology of ovarian cancer: a review,” Cancer Biology & Medicine, vol. 14, no. 1, pp. 9–32, 2017. [2] S. Mun, S.-H. Jang, and A. Ryu, “Early stage ovarian carcinoma with symptoms mimicking tuberculous peritonitis in a postmen- opausal woman,” Medicine, vol. 97, no. 40, article e12669, 2018. [3] S. Razi, M. Ghoncheh, A. Mohammadian-Hafshejani, H. Aziznejhad, M. Mohammadian, and H. Salehiniya, “The incidence and mortality of ovarian cancer and their relation- ship,” Ecancermedicalscience, vol. 10, 2016. [4] K. S. Okunade, H. Okunola, A. A. Okunowo, and R. I. Anorlu, “A five year review of ovarian cancer at a tertiary institution in Lagos, South-West, Nigeria,” Nigerian Journal of General Practice, vol. 14, no. 2, pp. 23–27, 2016. [5] D. Saranath and A. Khanna, “Current status of cancer burden: global and Indian scenario,” Biomedical Research Journal, vol. 1, no. 1, pp. 1–5, 2014. [6] C. A. Iyoke and G. O. Ugwu, “Burden of gynaecological cancers in developing countries,” World Journal of Obstetrics and Gynecology, vol. 2, no. 1, pp. 1–7, 2013. [7] E. S. Paik, J. H. Kim, T.-J. Kim et al., “Prognostic significance of normal-sized ovary in advanced serous epithelial ovarian cancer,” Journal of Gynecologic Oncology, vol. 29, no. 1, article e13, 2018. [8] A. Adesina, D. Chumba, A. M. Nelson et al., “Improvement of pathology in sub-Saharan Africa,” The Lancet Oncology, vol. 14, no. 4, pp. e152–e157, 2013. [9] I. O. Morhason-Bello, F. Odedina, T. R. Rebbeck et al., “Challenges and opportunities in cancer control in Africa: a perspective from the African Organisation for Research and Training in Cancer,” The Lancet Oncology, vol. 14, no. 4, pp. e142–e151, 2013. [10] J. O. Schorge, L. M. Halvorson, K. D. Bradshaw, J. I. Schaffer, B. L. Hoffman, and F. G. Cunningham, Ginecologia de Williams, McGraw Hill Brasil, 2011.

Journal

Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: Mar 11, 2020

There are no references for this article.