Cisplatin chemotherapy for haemostasis in bleeding cervical cancer: experience from a resource-poor setting.

BACKGROUND: Cervical cancer is the commonest cancer in northern Nigeria. There are only two radiotherapy centers in the north and four centres in the south, each with only one megavoltage machine for a population of over 140 million. The number of patients requiring radiotherapy for various malignancies is beyond the available facilities and expertise leading to long waiting time and disease progression with its attendant sequelae. This is the basis of using other orthodox treatment modalities as first line. PATIENTS AND METHODS: Between January 2006 and December 2007, 116 patients with histologically confirmed cervical cancer with vaginal bleeding as the predominant symptom were treated. Patients presenting with torrential haemorrhage were excluded from this study as they constitute oncologic emergencies. Patients were interviewed with a structured pro forma on a 3-weekly basis during chemotherapy schedules to assess and evaluate per vaginal bleeding and discharge. Dose of chemotherapy was 70 mg/m² every 3 weeks. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: The median age was 49 years (27-80 yrs). 62 patients were having per vagina bleeding for more than 6 months before commencement of chemotherapy (range 1-60 months). 49 patients had blood transfusion before chemotherapy, average of 2.7 pints of blood transfused per patient. 84 had at least FIGO stage IIIA disease. Squamous cell carcinoma is the commonest histology type followed by adenocarcinoma with 95 and 16 patients respectively. 81 patients had complete cessation of per vagina bleeding with 69 having complete cessation on or before 4th course of chemotherapy (9th week) and complete cessation of per vagina discharges was seen in 52 patients. 115 patients had a performance status KPS of below 80 prior to chemotherapy, and after completing 6 cycles, 100 patients had KPS of 80 and above. CONCLUSION: In resource-poor setting, Cisplatin based chemotherapy can be used by medical, gynaecological oncologists and general practitioners to control vaginal bleeding and improve the quality of life of patients pending radiotherapy. For optimal treatment with chemoradiotherapy, government and non-governmental agencies must do all it takes to remedy the problems of shortage of resources.

Heterotopic gestation with subsequent live birth in a Jehovah s Witness: a case report.

Heterotopic gestations occurring in spontaneous conception cycles are rare. An incidence of in has been documented. However there is a rising rate mostly attributed to ovulation induction and assisted reproduction techniques where it occurs in to of all clinical pregnancies. A high index of suspicion and use of ancillary investigations will aid diagnosis. The management of this condition in a Jehovah s Witness presents an uncommon challenge as surgical intervention aims to salvage the intrauterine pregnancy whilst giving scrupulous attention to haemostasis. This is because blood transfusion is precluded in the management of haemorrhage in members of this sect. We present a case of heterotopic gestation that occurred spontaneously in a Jehovah s Witness she had emergency salpingectomy and subsequently had spontaneous vertex delivery of a live baby at term.