Clinical Pathological Characteristics, Management and Outcomes of Patients Treated for Cervical Adenocarcinoma at Kenyatta National Hospital; 2013-2022

Abstract

Background In Africa, cervical cancer is the second most common cause of cancer in women and the leading cause of mortality. In KNH, it's the most common gynaecological malignancy. According to the SEER database, cervical adenocarcinoma is on the rise and affects mainly younger patients. Objectives: The broad objective was to evaluate the characteristics, management and outcomes of patients treated for cervical adenocarcinoma in KNH. Methodology: This was a retrospective descriptive cohort study on 130 patients with cervical adenocarcinoma admitted from 1 January 2013 to 31 December 2022. Description of data analysis was per objective. Results On the clinical characteristics, the mean age of the patients with cervical adenocarcinoma was 49.5; 90% had NHIF, 48% were multiparous, 43% were grand multiparas, and 54% of the patients were HIV positive. On pathological characteristics, 92% had never had cervical cancer screening, and 73% had symptoms for more than seven months or more before seeking treatment. On diagnosis, 21% had FIGO stage 1, 38% had stage 2 disease, while stage 3 and stage 4 were 26% and 15%, respectively. The majority of the patients, 52%, were treated with EBRT and brachytherapy, 28% were treated with radical hysterectomy, and 13% were treated with chemotherapy, while 8% were treated with EBRT alone. On treatment outcomes, 32% went into remission, 29% had recurrence, 20% had disease progression, 18% were lost to follow-up, and 2% had resistant residual disease. Majority of the patients that went into remission had stage 1 and stage 2 disease at 43% and 45% respectively, were HIV negative at 63% and were treated primarily by radical hysterectomy. On recurrence, the majority at 76% were treated with EBRT and brachytherapy, had symptoms for more than 1 year at 33%, had stage 3 disease (49%) and had poorly differentiated cervical adenocarcinoma at 51%. Most of the patients that had progression of the disease were HIV positive (65%), had stage 4 disease at 58%, 62% had poorly differentiated adenocarcinoma, and 54% were treated with chemotherapy alone. Most of the 2 patients lost to follow-up had early disease and were treated with radical hysterectomy at 69.6%. Conclusion Most patients in this study had never had cervical screening done. The majority of the patients that went into remission had radical hysterectomy as primary treatment. Recommendations Emphasis should be made on cervical cancer screening to the general population on education, policy-making and integration of health clinics to include cervical cancer screening. Recommendation for surgery in early-stage disease as it offers better prognosis Digitalization in documentation in KNH using health information systems to avoid having missing data in files.