EP291/#959 Dying undiagnosed: challenges of management of pelvic masses in a resource-poor setting in Northwestern Nigeria

Abstract

Introduction Ovarian cancer is the second most prevalent but most lethal gynaecologic malignancy in our institution. The study aimed at determining the rate of non-diagnosis in patients with pelvic masses suspicious for ovarian malignancy while reviewing the management challenges Methods A three-year review of patient records was carried out. Cases with high indices of suspicion for ovarian cancer were identified by criteria including pelvic masses with malignant radiographic features, ascites, pleural effusion, cachexia, anemia, or metastatic disease. This multidisciplinary study was done in collaboration with consultants from radiology, radiation oncology, pathology, and gynaecologic oncology Results One hundred and twenty-two cases highly suspicious for ovarian malignancy were identified with a mean age of 40.6 years. Of these, 28 (23%) had surgery and 77% did not have any form of histological diagnosis. Of those that had surgery, 13 (46.4%) had upfront surgery and 15 (53.6%) neoadjuvant chemotherapy followed by interval debulking surgery. Only two cases had documented complete (R0) debulking. Among those that had upfront surgery, one case was an ovarian fibroid and one was a fibrosarcoma while two cases (15.4%) were borderline tumours. Chemotherapy was commenced based on malignant cells on ascitic or pleural fluid cytology in three cases. Epithelial carcinomas accounted for 48% of cancers Challenges include late presentation, insufficient funding, unavailable interventional radiology, immunohistochemistry, genetic testing, and maintenance therapies, high cost of chemotherapy, inadequate skill, unaffordable/erratic imaging et cetera Conclusion/Implications Based upon our data, most patients with tumours highly suspicious for ovarian cancers probably die undiagnosed. Management of ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options.