Browsing by Author "Adams, Tracey"

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    A Review of Women with Epithelial Ovarian Carcinoma in a Middle-Income setting: Groote Schuur Hospital, Cape Town, South Africa: Demographics, Treatment and Outcomes of Patients between 2005 and 2015
    (2024) Loggenberg, Francisca; Adams, Tracey
    Background: In 2020 there were 313 959 new cases of Ovarian carcinoma worldwide.1 It is one of the most challenging female gynaecological cancers to manage with a poor prognosis for latestage disease and high recurrence rates. Ovarian Carcinoma ranks 8th amongst new cancer cases in women and accounts for 4.7% of reported cancer deaths.1 Women often present late with advanced disease of which the prognosis remains poor. The 5-year survival rate of stage 3 disease being 52-59% and only 17% for stage 4B disease.2 Overall the 5-year survival rate of many malignancies have improved over the past 30 years due to advances in screening, diagnosis and treatment, but despite these advances the survival rate of ovarian carcinoma has shown only a modest improvement.3 Methods: The study is a retrospective descriptive study of patients with epithelial ovarian carcinoma treated at Groote Schuur Hospital in Cape Town between 2005 and 2015. The study included all patients with epithelial ovarian carcinoma registered with and treated at our combined multidisciplinary clinic. There were 168 patients included in this study. Data was collected from patient folders and an existing cancer database(R016/2013). Data collection sheets were used and the data was entered into a secure database for analysis Results: The study population included 168 patients. The mean age was 59.4 years (standard deviation 11.6). High grade serous ovarian carcinoma was the most prominent histology accounting for 64.3% of cases. Endometroid and Mucinous histology was reported in 12.5% and 11.9% of cases respectively. Only 33.9% of patients presented with early-stage disease. Patients with advanced stage disease accounted for 66.1% of our study population. Of the 163 patients who underwent primary cytoreductive surgery, 72 (44.2%) patients were completely debulked with no residual disease, 18 (11%) were optimally debulked to less than 1cm residual disease and 72 (44.2%) still had gross residual disease. A complete response was achieved in 62.5% of our patients, 60 (57.1%) of these patients had recurrent disease with a median time to recurrence of 11.5 months. The median overall survival was 27.2 months with 5-year overall survival of 21%. The 5-year disease specific survival was 27%. Conclusion: Ovarian carcinoma remains one of the most challenging gynaecological malignancies to manage even in high resource settings. Rates of complete cytoreductive surgery were lower at our unit than reported in high income settings. Recurrence rates were high with shorter time to recurrence. The median survival of our patients was also much shorter than reported in literature. This may reflect the limitations in limited resource setting when managing patients with epithelial ovarian carcinoma.
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    Borderline ovarian tumours in a middle-income country setting: a ten-year retrospective review of cases in a tertiary hospital in South Africa
    (2025) Ghunney, Ama; Rogers, Linda; Adams, Tracey
    The diagnosis and management of borderline ovarian tumours remain controversial almost a century after their initial description, and little research has been done in Africa to provide answers on the prevalence and outcomes of these tumours. This study is a review of cases of borderline ovarian tumours seen in Groote Schuur Hospital over a ten-year period. Objective: To describe the demographic characteristics, occurrence, treatment, and outcomes of women diagnosed with borderline ovarian tumour at Groote Schuur Hospital, a tertiary hospital in South Africa. Methods: A retrospective review of women diagnosed with borderline ovarian tumour in Groote Schuur Hospital between January 2005 and December 2014 was undertaken by reviewing our gynaecological oncology database and patients' folders. Women with multiple primary tumours, lost to follow-up, or with inadequate clinical data were excluded. Demographic characteristics, preoperative, operative, postoperative, oncologic, and pathologic data was retrieved and analyzed. Results: Ninety-one patients were diagnosed with borderline ovarian tumour in the study period. Nineteen were eliminated and 72 analysed. Borderline ovarian tumours accounted for 22.3% of 409 ovarian neoplasms registered with our gynaecological oncology database in the study period. The median age was 48.5 years, (range, 16–82 years) with 31.9% (n=23) of women less than 40 years of age. Seventy-point eight percent (n=51) of patients were completely surgically staged and 80.6% (n=58) were optimally debulked. Thirty-one-point nine percent (n=23) underwent fertility-sparing surgery and of these 17.4% (n=4) had completion surgery. Mucinous histology was the most common histological subtype (57%). The median time to recurrence was 42.9 months (range 1.0 to 108.0 months). Serous histology and fertility-sparing surgery were independently associated with recurrence (p=0.016, p=0.026 respectively). Our overall recurrence rate was 13.9% (n=10) with 40% of these being invasive (n=4). The 5-year overall survival rate was 91.7% and the 5-year relapse- free survival rate was 89.9%. Despite small numbers, all patients with invasive recurrence died within 5 years of recurrence, whiles all patients who recurred with borderline histology were alive 5 years after recurrence. Conclusion: Mucinous histology was the most common histological subtype (57%). Regardless of a generally favourable prognosis, patients who recurred as invasive disease were all dead 5 years after recurrence, whiles patients who recurred with borderline histology were all alive 5 years after recurrence.
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    Borderline ovarian tumours in a middle-income country setting: a ten-year retrospective review of cases in a tertiary hospital in South Africa
    (2025) Ghunney, Ama; Rogers, Linda; Adams, Tracey
    The diagnosis and management of borderline ovarian tumours remain controversial almost a century after their initial description, and little research has been done in Africa to provide answers on the prevalence and outcomes of these tumours. This study is a review of cases of borderline ovarian tumours seen in Groote Schuur Hospital over a ten-year period. Objective: To describe the demographic characteristics, occurrence, treatment, and outcomes of women diagnosed with borderline ovarian tumour at Groote Schuur Hospital, a tertiary hospital in South Africa. Methods: A retrospective review of women diagnosed with borderline ovarian tumour in Groote Schuur Hospital between January 2005 and December 2014 was undertaken by reviewing our gynaecological oncology database and patients' folders. Women with multiple primary tumours, lost to follow-up, or with inadequate clinical data were excluded. Demographic characteristics, preoperative, operative, postoperative, oncologic, and pathologic data was retrieved and analyzed. Results: Ninety-one patients were diagnosed with borderline ovarian tumour in the study period. Nineteen were eliminated and 72 analysed. Borderline ovarian tumours accounted for 22.3% of 409 ovarian neoplasms registered with our gynaecological oncology database in the study period. The median age was 48.5 years, (range, 16–82 years) with 31.9% (n=23) of women less than 40 years of age. Seventy-point eight percent (n=51) of patients were completely surgically staged and 80.6% (n=58) were optimally debulked. Thirty-one-point nine percent (n=23) underwent fertility-sparing surgery and of these 17.4% (n=4) had completion surgery. Mucinous histology was the most common histological subtype (57%). The median time to recurrence was 42.9 months (range 1.0 to 108.0 months). Serous histology and fertility-sparing surgery were independently associated with recurrence (p=0.016, p=0.026 respectively). Our overall recurrence rate was 13.9% (n=10) with 40% of these being invasive (n=4). The 5-year overall survival rate was 91.7% and the 5-year relapse- free survival rate was 89.9%. Despite small numbers, all patients with invasive recurrence died within 5 years of recurrence, whiles all patients who recurred with borderline histology were alive 5 years after recurrence. Conclusion: Mucinous histology was the most common histological subtype (57%). Regardless of a generally favourable prognosis, patients who recurred as invasive disease were all dead 5 years after recurrence, whiles patients who recurred with borderline histology were all alive 5 years after recurrence.
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    A quality of care assessment of the management of obstetric haemorrhage in the Peninsula Maternal and Neonatal Services
    (2009) Adams, Tracey; Fawcus, Susan R
    In South Africa obstetric haemorrhage is the third most common cause of maternal deaths. In addition to maternal mortality audits, quality of care audits using criterion based audit methodology provides useful information. The aim of this study was to audit the management of all women with severe obstetric haemorrhage in the Peninsula Maternal and Neonatal Services in order to improve management. A descriptive retrospective audit was conducted during the period August 2006 to August 2007 using a criterion based audit methodology. Cases of severe obstetric haemorrhage were identified prospectively. Folders were reviewed and data collection sheets utilized to: 1. Describe the demographics and causes of obstetric haemorrhage in the Peninsula Maternal and Neonatal Services, 2. Measure the case fatality ratio, 3. Describe the management of women with severe obstetric haemorrhage with reference to that prescribed in the South African National Guidelines (2002-2004), 4. Score the management provided by the Peninsula Maternal and Neonatal Services using a shorter checklist devised from the National Guidelines.
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    The impact of positive margins and crypt involvement in excisional procedures of the cervix on recurrence rates of premalignant diseases of the cervix
    (2021) Addae, Haleema; Adams, Tracey
    BACKGROUND Recurrent disease after cervical excisional procedures has been linked to many factors. We aim to determine if positive margins and crypt involvement increased the rate of recurrence of premalignant disease in patients who had excisional procedures. METHODS In this retrospective review of the colposcopy database, patient records and pathology database, women who had cervical excisional procedures at the Groote Schuur Hospital colposcopy clinic in 2010 were followed up until 2015. Recurrence was based on high grade cytology or histology at follow up. Chi-square tests were used to compare recurrence rates. RESULTS Two hundred and seventy women were included in the final analysis. 130 women had CIN 3 and 94 had CIN 2 at the excisional procedure. Eighty five (31.5%) had endo-margin involvement, 46 (17%) had ecto-margin involvement, and 24 (8.9%) had dual margin involvement. Two hundred and thirteen (79.2%) had crypt involvement. Recurrence occurred in 30 (19.4%) of the 155 patients we had follow up data on. Of those that recurred, 19 (P<0.001) had positive endo-margin involvement, 10 (P=0.007) had ecto-margin involvement, 9 (P< <0.001) had dual margin involvement, and 28 (P=0.058) had crypt involvement. 155 women (43%) were lost to follow-up CONCLUSION Positive margins at excisional procedure of the cervix have a statistically significant increased risk of recurrence of pre-malignant disease. There was a trend towards recurrence of disease in those who have crypt involvement. In limited resource setting follow up protocols can be adjusted so that women without margin involvement can be seen at longer intervals.
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    The incidence, management and outcomes of stage IIIB cervical cancer in a low- and middle-income setting
    (2025) Dalvie, Zaeem; Fakie, Nazia; Adams, Tracey
    Background: Cervical cancer is the second most common cancer in South Africa with stage III being the most common presenting stage. Hydronephrosis is a frequent complication in advanced disease and is associated with poorer outcomes. This review aims to evaluate the management and outcomes of patients with stage IIIB cervical cancer. Aim: To describe the incidence, treatment offered and outcomes in women with stage IIIB cervical cancer in a middle-income setting. It further aims to evaluate these differences in women with pelvic sidewall (PSW) involvement alone versus PSW with unilateral and bilateral hydronephrosis. Objectives: Determine the overall survival and disease-free survival of patients with stage IIIB cervical cancer with specific attention to those patients with hydronephrosis, determine the incidence of unilateral and bilateral hydronephrosis, determine how many patients with bilateral hydronephrosis were offered percutaneous nephrostomies, describe the treatment offered and outcomes of the women who were offered nephrostomies, describe the complications that arose by inserting nephrostomies, and to determine how many patients with hydronephrosis received concurrent chemoradiation. Methods: A retrospective audit was conducted to review clinical data of a cohort of patients who received treatment for stage IIIB cervical cancer at Groote Schuur Hospital between January 2017 and December 2018. The data collected included age, HIV status, comorbidities, pelvic sidewall involvement, hydronephrosis, treatment intent, treatment modalities, nephrostomy referral, treatment response and survival outcome. Results: A total of 132 patients were deemed eligible for our study with a mean age of 52. There was no statistically significant association between overall survival and disease-free survival with age and comorbidities apart from HIV. The median overall survival was 15 months and median disease-free survival for patients who completed radical treatment was 13 months. Overall survival and disease-free survival between presence and absence of hydronephrosis was not statistically significant. Conclusions: Hydronephrosis was not found to have a statistically significant impact on overall survival or disease-free survival. There remains a place for percutaneous nephrostomies in the acute setting and is preferred over ureteral stents in a resource-constrained setting. HIV was found to have an association with increased incidence of stage IIIB cervical cancer, as well as a negative prognostic factor for overall survival and disease-free survival.