Cervical Cancer Screening in a Human Immunodeficiency Virus Treatment Centre in Zaria North-Western Nigeria.

INTRODUCTION: Low awareness and lack of adequate services for cervical cancer screening and treatment of premalignant lesions of the cervix have been identified as some of the reasons for the high burden of cervical cancer in Sub-Saharan Africa. Women living with HIV infection are at a higher risk of developing cervical cancer than HIV negative women. OBJECTIVE: The study sought to assess the awareness of cervical cancer and screening services among women living with HIV in a HIV treatment centre. Factors that affect uptake of screening were also explored. METHODS: It was a qualitative study conducted from 26th August to 9th September 2019, in a HIV treatment centre in Zaria. A total of 61 HIV positive women participated in ten focus group discussions. Two key informant interviews were conducted with health care providers in the center. RESULTS: Majority of the participants have heard about cervical cancer and cervical cancer screening during routine health talk in the clinic, however, most of them were not aware of the increased risk of cervical cancer among women living with HIV. Uptake of screening was low. Stigma, cost and lack of screening facility within the treatment center were the main barriers to screening uptake. CONCLUSION: From our study, uptake of cervical cancer screening among women living with HIV was low. There is need to integrate cervical cancer screening services within the compact of care offered to all women living with HIV within HIV treatment centres.

INTRODUCTION: La faible sensibilisation et le manque de services adéquats pour le dépistage du cancer du col de l'utérus et le traitement des lésions précancéreuses du col de l'utérus ont été identifiés comme certaines des raisons du fardeau élevé du cancer du col de l'utérus en Afrique subsaharienne. Les femmes vivant avec le VIH sont plus à risque de développer un cancer du col de l'utérus que les femmes séronégatives. OBJECTIF: L'étude visait à évaluer la connaissance du cancer du col de l'utérus et des services de dépistage chez les femmes vivant avec le VIH dans un centre de traitement du VIH. Les facteurs qui affectent le recours au dépistage ont également été explorés. MÉTHODES: Il s'agit d'une étude qualitative menée du 26 août au 9 septembre 2019, dans un centre de traitement du VIH à Zaria. Au total, 61 femmes séropositives ont participé à dix discussions de groupe. Deux entretiens avec des informateurs clés ont été menés avec des prestataires de soins de santé du centre. RÉSULTATS: La majorité des participants ont entendu parler du cancer du col de l'utérus et du dépistage du cancer du col de l'utérus lors de discussions de routine sur la santé à la clinique, cependant, la plupart d'entre eux n'étaient pas au courant du risque accru de cancer du col de l'utérus chez les femmes vivant avec le VIH. Le recours au dépistage était faible. La stigmatisation, le coût et le manque d'installations de dépistage au sein du centre de traitement étaient les principaux obstacles à l'adoption du dépistage. CONCLUSION: D'après notre étude, le recours au dépistage du cancer du col de l'utérus chez les femmes vivant avec le VIH était faible. Il est nécessaire d'intégrer les services de dépistage du cancer du col de l'utérus dans le cadre des soins offerts à toutes les femmes vivant avec le VIH dans les centres de traitement du VIH. Mots clés: Sensibilisation au cancer du col de l'utérus, Dépistage du cancer du col de l'utérus, Femmes vivant avec le VIH.

Pattern of oncologic emergencies seen in adult cancer patients attending the Radiotherapy and Oncology Centre, Ahmadu Bello University Teaching Hospital, Zaria - Nigeria.

AIMS AND OBJECTIVES: To evaluate the Pattern of Oncologic Emergencies seen in Adult cancer patients and the treatment modalities used. MATERIALS AND METHODS: Between January 2004 and December 2008, a total of 1824 (M:F = 1:1.8) new patients were seen. 196 (M:F = 1:1.4) consecutive patients with histologically confirmed malignancies presenting with or having oncologic emergencies were treated and have been reviewed. Patients' folders were reviewed retrospectively with a structured pro forma. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: The median age was 49 years and mean age of 42 years (range, 15 - 82 years). M: F = 1:1.4. 162 patients had oncologic emergencies at presentation while 21 during treatments and 13 during follow up. At the time of diagnosis of oncologic emergency, 126 were not on any treatment, 42 patients on hormonal therapy and 28 patients were on diverse chemotherapy. All the patients presented late with 108 patients presenting with metastatic disease and 88 patients with locally advanced disease. Only 35 patients were treated within 1 week of onset of emergency. 59 patients had cervical cancer, 31 patients with breast cancer and 28 patients with prostate cancer. Tumour haemorrhage wass the commonest oncologic emergency seen in 107 patients followed by bone pain with imminent cord compression from bone metastases in 59 patients. Of 107 patients with tumour haemorrhage, 54 patients had cardiovascular collapse with 7 having acute renal failure. Similarly, of the 107 with tumour haemorrhage, 56 patients bled from cervical cancer, 12 patients from breast cancer and 8 patients from urinary bladder. 129 patients were treated with teletherapy, 31 patients had chemotherapy, 27 patients had emergency surgery and 5 patients had chemoradiation. Oncologic emergencies were corrected in 126 patients. CONCLUSION: Tumour haemorrhage is the commonest oncologic emergency in this environment and teletherapy is the commonest therapy used. More radiotherapy centres are needed for prompt treatment and their usefulness in managing emergencies should be made known. Oncologic emergencies are commonly seen in metastatic and locally advanced disease.

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.