The gynaecology long commentary review of gynaecological cancer morbidity in provincial general hospital Kakamega

Abstract

Background. Despite the socioeconomic improvements and the development of interventions, little progress has been made in reducing the prevalence of reproductive tract cancers in the recent decades especially in the developing countries. Cancer of the cervix accounts for 37% of all histologically proven cancers in Afiican women and is the most common female genital tract tumour in Kenya and sub-Saharan Afiica (5). In America, endometrial cancer is the most common genital tumour. This was a retrospective descriptive study carried out at Provincial General Hospital (pGH) Kakamega. Objectives. To assess the gynaecological cancer prevalence in PGH Kakamega in the period 1'1 January 1997 and 31st December 2001. Study population. This comprised patients who were admitted in the gynaecological ward with genital cancers. Methodology. Of the 217 women diagnosed with reproductive tract malignancies at Provincial General Hospital Kakamega, their sociodemographic characteristics, presenting symptoms and signs and the proportion of patients admitted into the gynaecological ward with gynaecological cancers were studied. In addition, the clinical diagnosis and staging and the histologically verified report from the case files in the period stated were studied and entered in a questionnaire. Results. Of the gynaecological admissions, 41551100,000 were due to gynaecological malignancies. The age of the patients ranged from 15 to 82 years with a mean of 43 .1± 11 years. Most patients were married (82%), had no formal education or attained primary school level of education (82.9%). Approximately 73% were unskilled and 61.3% had delivered more than two times. Most patients presented with vaginal bleeding (21.2%), abdominal pains (17.5%) and abdominal swelling (16.6%). Most (80%) were pale and 33.6% had a foul smelling discharge. A total of 178(82%) patients had clinical diagnosis and staging done for the cancer. Cancer of the cervix was the most common (67.3%), followed by ovarian cancer (12.4%), uterine malignancy (9.7%) and vulva cancer (5.1 %). Other genital malignancies encountered were choriocarcinoma and vaginal malignancy. Only 84(47.2%) patients had a histological verification of the diagnosis. Conclusions. Clinically diagnosed genital malignancies are very prevalent in the rural populations with most of them not being confirmed histologically. Majority of the patients present with advanced and late stage diseases and the few who present early are not managed appropriately. Recommendations. A proper and uptodate health information system with qualified staff in record keeping is needed in this hospital. A pathologist needs to be posted at the hospital. Cervical screening and training staff in this area should urgently be addressed