The frequency of epithelial ovarian cancer subtypes in Sudanese women at Omdurman Maternity Hospital, 2013-2018: A cross-sectional study

Introduction

Ovarian carcinoma (OC) is the second most frequent gynecological cancer in developing countries and globally^1,2. They are the fifth most mortal disease in women^3,4, and in 2018, ^~22,240 new events and 14,070 deaths were associated with OCs in the United States^5,6. In Sudan, OCs ranked as the fourth highest malignancy in women, with an incidence rate of ^~188 for every 100,000 people, which is 8 for every 100,000 people when gender is specified, and 7 for every 100,000 people with an age-standardized rate^7,8.

Epithelial ovarian carcinoma (EOC) is the most widespread and has the highest mortality of OC^1,9, with high-grade serous ovarian cancer classed as the deadliest sub-type^10,11. In the United State, generally, EOC has been considered an age-related disease; women aged >65 years are considered the target population^12,13. Although the incidence of OCs is decreasing, in the majority of cases, distant metastasis is seen at diagnosis^14,15. Surgery and chemotherapy are the most important treatments of this cancer but are efficient only in the early stages^16,17. Currently; the prognosis for this cancer is still poor, and the five-year survival rate remains low^18,19. In Sudan, scarce publications are available about the frequency and incidence of EOC. The present study intended to evaluate the morphological sub-types in Sudan using data from one hospital, sort the disease by age and grade and compare the results with similar studies in other regions of Sudan and other countries.

Methods

Results

This study was conducted among 70 new EOC cases. The median age of participants was 50 years (range, 18 – 75 years). In total, 48.6% (n=34) of the participants were in the age group ≤ 50 years(18 to 50 years), and 44.3% (n=31) were in the age group > 50 years (51 to 75 years).The frequency of common histological subtypes is shown in Figure 1. The results showed that the majority of the cases were low grade (51.4%; n=36) compared with high grade (48.6%; n=34).

Figure 1. Frequency of epithelial ovarian carcinoma histological sub-types among Sudanese women.

Our results showed significant associations between EOC tumor types and EOC tumor grades (Fisher’s Exact test, p = 0.000) and no significant associations between tumor types and ages (Fisher’s Exact test, p>0.05).

Discussion

OCs are the most lethal gynecological malignancy worldwide and constitutes the fifth leading cause of cancer-related death in women^20,21. Comparison of the age distribution of new OC cases revealed that the median age of 50 years recorded in this study is similar to a local study from Gezira State, Sudan⁷, sub-Saharan African^22,23 and other developing countries²⁴. Nevertheless, it is lower than that reported from developed countries²⁵, for example a median age of 65 years was reported from the Netherlands²⁶. The lower age in this study may suggest an earlier onset or a more aggressive course of the disease in our environment. Also, it may be because Africa has the youngest population of any of the continents²⁷. Our study results indicate a younger presentation of EOC and warrants quick and thorough investigation of any vague abdominal complaint in women of a younger age (<50 years). In the present study, serous adenocarcinoma is the most frequent histological type (43.1%), which is supported by previous studies^28–30.

Conclusion

The present study revealed that contrary to some previously published data, EOC affected a larger proportion of younger Sudanese women. The most prevalent subtype of EOC is serous carcinoma. A further study of frequency and prevalence of EOCs in other parts of Sudan is needed.

Data availability