Improving ovarian cancer outcome by studying the clinicopathological characteristics at a tertiary care hospital

Objectives: to optimize the outcome of malignant ovarian tumour via evaluation of the management procedures and protocols in Man- soura university hospitals and how far they are from the international standards.
Method: This descriptive, observational analytical study was con- ducted at Mansoura University Hospital, oncology unit of the depart- ment of Obstetrics & Gynaecology from January 2016 to December 2017 and included 94 patients. The participants were chosen from those attending the gynaecology outpatient clinic and diagnosed clin- ically and proven by investigations as having ovarian cancer. Histo- ry, clinical examination and data obtained by abdominal and vaginal ultrasound as well as reports received from MRI and CT scanning we rereserved. Tumour markers were estimated by the same laboratory and technicians and treatment interventions provided with one year follow up results were collected.
Results: demographic patients’ data recorded the mean age estimat- ed for all patients is 45.28 ± 15.5 years, 42.5% of which are more than 50 years, and 6.4% younger than 18 years. Patients with low gravidity and parity included near half of the cohort (48.9 % and
44.7 respectively).Family history of ovarian, breast and colon can- cers were positive in 9 patients only. Premenopausal ones recorded the highest number. From all of the cohort 6 cases gave a history of infertility. The main complaint was abdominal discomfort (40 cas- es), followed by abdominal swelling (24). Epithelial ovarian can- cers were the most common (74.5%), with serous cyst adenocar- cinoma constituting the majority (68.6 %) followed by granulosa cell tumour (10.6%) then border line and germ cell tumours(6.4%) for each group. The least reported subclass was immature teratoma (1%). Two cases were found to be Krukenbergmetastasis from co- lonic cancer. CA125 mean was+SD 510.41 ± 131.42 IU/ml. AFP and HCG were elevated in germ cell tumour and sex cord tumour. Most of the patients (74.5%) presented with advanced stage disease III and IV, whereas 25.5% of patients presented with stage I and II. Eighty-eight patients did primary debulking surgery. Two patients received neoadjuvant chemotherapy followed by secondary debulk- ing surgery. The majority of patients (68%) had a combined surgery and chemotherapy.25.5% of the patients had the chance of fertility preserving surgery as they underwent unilateral oophorectomy. Es- timated cancer mortality in our cohort proved 18 cases died (19.1%) within a year after treatment, 76 patients (80.9%) survived beyond a year after the initial treatment. The stage of the disease at presenta-

tion was strongly correlated to survival beyond a year after treatment (p < 0.001).
Conclusion: mproving the health care system and promoting effective clinical management of ovar- ian cancer is an important issue to eliminate the survival disparities in our locality that requires im- provement in guidelines adherent care.