|Year : 2017 | Volume
| Issue : 1 | Page : 16-20
A histopathologic review of cervical cancer in Kano, Nigeria
Alfa Alhaji Sule, Ochicha Ochicha
Department of Pathology, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||11-Apr-2017|
Alfa Alhaji Sule
Department of Pathology, Bayero University, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Although cervical cancer is the most common gynecological malignancy globally, with high incidence in developing countries, there has been no formal study in our locality. We, therefore, undertook this review to document and evaluate the pattern in Kano, Northern Nigeria. Materials and Methods: This is 10 years (2002–2011) retrospective study of all cervical cancers diagnosed at the Pathology Department of Aminu Kano Teaching Hospital, Kano. Results: Five hundred and forty-five cervical cancers were diagnosed during the 10 years study. Patients' ages ranged from 20 to 80 years (mean 48.30 ± standard deviation 12.61 years), with highest occurrence in the fifth to seventh decade age group. Squamous carcinoma was by far the most common histological type (82.2%), distantly followed by adenocarcinoma (12.8%) and mesenchymal/mixed Mullerian malignancies comprising 0.01% (5 cases). Conclusion: Our findings were consistent with most published reports in Nigeria and sub-Saharan Africa but somewhat at variance with the developed world where cervical cancer is much less common and afflicts a slightly older age group.
Keywords: Africa, cervical cancer, gynecological malignancies
|How to cite this article:|
Sule AA, Ochicha O. A histopathologic review of cervical cancer in Kano, Nigeria. Sahel Med J 2017;20:16-20
| Introduction|| |
Cancer of the cervix is the most common gynecological malignancy and the second most frequent cancer in women worldwide. The incidence is much higher in the developing world than it is in the developed world where widespread cervical smear screening has markedly lowered the incidence.
The introduction of human papillomavirus (HPV) vaccination programs among adolescent females in some developed countries is likely to widen the cervical cancer gap between developed and developing countries. Furthermore, the global HIV pandemic which has more severely impacted on sub-Saharan Africa and parts of the developing world also increases the burden of cervical cancer in the third world, as cervical cancer is an AIDS-defining malignancy.
Some studies also suggest a disparity in histological types between the first and third worlds., While squamous carcinoma remains overwhelmingly preponderant in the developing world, its frequency has slightly declined in the developed world, with relatively increased in the prevalence of adenocarcinoma.
In Nigeria, cervical cancer is the most frequent female genital malignancy, constituting 62.3–70.5% of gynecological cancers., There has, however, being no formal study of this common malignancy in Kano, the largest city in Northern Nigeria, hence this review. The aim of this study was to analyze the frequency and morphological patterns, as well as to compare our findings with other studies from different geographical locations of the world.
| Materials and Methods|| |
This is 10 years (2002–2011) retrospective review of all cervical malignancies diagnosed at the Pathology Department of Aminu Kano Teaching Hospital (AKTH). AKTH is the premier referral center in Kano state as well as some of the neighboring states.
Ethical clearance was obtained from hospital ethics committee and biodata derived from pathology laboratory records.
Histology slides on all cases were retrieved and reviewed by the authors. Fresh sections were cut from archival paraffin blocks when slides could not be retrieved.
All specimens had been fixed in 10% formal saline then routinely processed for paraffin embedding. Microtome sections were cut at 4 μ and stained with hematoxylin and eosin. Special stains such as mucicarmine for mucin were deployed where necessary. Biodata on all cases was retrieved from laboratory records. Collated results were presented in the form of tables and photomicrographs.
| Results|| |
A total of 545 histologically diagnosed cervical cancers were seen during the 10-year study. Patients' ages ranged from 20 to 80 years with mean of 48.3 years (±standard deviation 12.61). The overwhelming majority (80%) of patients were within the fifth to seventh decade age group, peaking in the 5th. Squamous carcinoma mostly occurred in a slightly older age group (fifth to seventh decades), than adenocarcinoma (fourth to sixth decades). Most 521 (95.6%) of the biopsies were incisional with only 24 (4.4%) being hysterectomies.
[Table 1] shows the relative frequency and age distribution of different histological types. Carcinomas were overwhelmingly preponderant comprising 99.1% (540 cases), distantly followed by 4 carcinosarcomas (0.7%) and one leiomyosarcoma (0.2%).
|Table 1: Histological types and age distribution of cervical cancers in Kano|
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Squamous cell carcinoma was by far the most common histological type accounting for 82.2% (448 cases), followed by adenocarcinoma (12.8%), and other infrequent tumor subtypes.
Of the adenocarcinomas, nearly three-quarters were endometrioid (52 cases), with 12 clear cell and 6 mucinous subtypes.
[Table 2] and [Table 3] depict the age and frequency distribution of squamous versus nonsquamous cell malignancies of the cervix in Kano from 2002 to 2011. Comparing the two age groups [Table 2], the χ2 = 13.69 and P = 0.02.
|Table 2: Age distribution of squamous versus nonsquamous cell malignancies of the cervix in Kano from 2002 to 2011|
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|Table 3: Frequency distribution of squamous versus nonsquamous cell malignancies of the cervix in Kano between 2002 and 2011|
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[Figure 1] and [Figure 2] show the photo-micrograph of large cell nonkeratinizing squamous cell carcinoma and mucinous adenocarcinoma of the cervix respectively.
|Figure 1: Large cell nonkeratinizing squamous cell carcinoma (H and E ×20)|
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| Discussion|| |
There were 545 cases of cervical cancers during the 10-year study which represents 46.6–58.5% of all gynecological cancers in Kano. This is consistent with most other sub-Saharan African studies but at variance with the developed world where cervical cancer is relatively less common and is exceeded by endometrial and ovarian cancers as the common gynecological malignancies.,
The overall age range of patients with invasive cervical cancer was 20–80 years, peaking in the fifth decade (131 cases). This was followed by patients in the sixth decade (127 cases). The mean age was 48.3 years, which is lower than most other parts of the world, the mean age was 47.9 years in Egypt, 52.1 years in Tunisia, 53 years in Brazil, 52.4 years in Italy, and 51.4 years in the USA.,,,, The mean age in this study corroborates other Nigerian studies – 44.5 years in Zaria, 42 years in Ibadan, and 48 years in Sokoto.,,
Thus, it appears the mean age in Nigeria is somewhat lower than most other middle and high-income countries. Racial differences, as well as environment factors like poor access to proper medical care with prompt treatment of synergistic sexually transmitted infections, are probably involved here in our environment.
In this series, 68% of squamous carcinomas occurred in the fifth to seventh decade. This is consistent with findings in other parts of the country where most patients fell within the 40–69 years age bracket.,,
Most 521 (95.6%) of the biopsies were incisional with only 24 (4.4%) being hysterectomies. Squamous cell carcinoma emerged the most frequent histological type, comprising about 82.2% of cases. This is quite similar to studies from other countries such as Tunisia (90.5%), India (90%), and the USA (85%).,, In other Nigerian studies, squamous cell carcinoma was also the most common with a prevalence of 95% in Zaria, 93% in Ibadan, 92% in Maiduguri, and 85.7% in Ilorin.,,, Nonkeratinizing type (46.2%) was the most common variant of squamous carcinoma in this study, followed by keratinizing variant (33%). This is similar to findings by Lowe et al. in Malawi and Mandong in Jos., It is at variance with studies in the USA, Ibadan, and Ilorin where nonkeratinizing squamous cell carcinomas comprised 61.2%, 63.2%, and 60.1%, respectively.,, Thus, there appears to be no consistent pattern within the country, or globally.
Adenocarcinoma was the second most common histological type in this study constituting 12.8% of cervical cancers in Kano. Although absolute number remains relatively small, increasing incidence of cervical adenocarcinoma has been reported in several developed nations.,
With just one leiomyosarcoma (0.2%) documented in this 10-year study, mesenchymal malignancies of the cervix were uncommon. This is comparable to 0.5% reported by Platz in the USA.
From result above, comparing the two periods with significant association (P = 0.02), it means that there may be an increase in squamous cell carcinomas over the nonsquamous cell malignancies in the study period. Furthermore, there was a gradual increase in frequencies of nonsquamous cell malignancies over the years during the study. This is mainly due to the effectiveness of cervical screening program, squamous cell carcinoma precursors are frequently detected in Pap smear More Detailss, and can generally be readily visualized by colposcopy and eradicated. On the other hand, adenocarcinoma precursors are often difficult to identify because it often arises deep in the endocervical canal, the area that is not easily sampled during a routine screening and hence invasive adenocarcinoma is often present by the time the tumor is detected.
| Conclusion|| |
Cervical cancer is quite common in our setting which necessitates data for health planning and policy decisions. Recommendations include health education and awareness on the need for all women to have Pap smear screening from puberty, cervical smear screening (training of cytoscreeners, funding for free screening, etc.), HPV vaccination, colposcopy training for Gynecologists, provision of radiotherapy facilities for cancer treatment, facilities and training in cytogenetic techniques for HPV typing in pathology laboratories.
We are grateful to Mr. Sani for laboratory work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]