Ppt

1. PHARMACY DEPARTMENT
JOS UNIVERSITY TEACHING
HOSPITAL
(JUTH)
A Presentation On:
The Prevalence Of Viral Induced Cancers In Patients Seeking Care In The Obstetrics
And Gynecology Department Of Jos University Teaching Hospital
BY
OTI ELECHI B. PHARM
PRECEPTOR: PHARM PYENTIM PONFA (ADPS)
DECEMBER, 2022
3/14/2023
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2. Content
Introduction
Statement of problem
Justification of the study
Aim
Objectives
Method
Results and Discussion
Conclusion
Limitations
References
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3. Introduction
• Cancer is the final result of a number of genetic alterations occurring in a cell
• These changes may alter the balance between proliferation and programmed cell death
(apoptosis) mechanisms and transform the cell
• Malignant transformation is divided into stages of initiation, promotion and progression
• Usually, there is a long latent period from the moment of carcinogenic exposure to the
neoplastic transformation in which the somatic cell is allowed to proliferate while
accumulating multiple genetic mutations that might lead to a disease in an individual (Gan
DD, 2013)
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4. • Multiple factors have been associated with the oncogenic process such as
environment, lifestyle, host factors, infectious agents and inheritance
• Understanding cancer etiology and risk factors is a useful tool to help identify
high-risk populations, and improve screening procedures and preventive
methods
• Among these risk factors, infectious agents may be one important preventable
cause of cancer
• Within this group, viruses are the most common agents involved in the
pathogenesis of human cancer (Karakosta A, 2015)
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5. • In the past decades, viruses have played an important role in cancer biology, contributing
significantly in our comprehension of cell signaling and growth control pathways that result in
cancer
• This insight has been achieved through the study of viral transforming properties.
Consequently, viruses have been suggested as causative agents of human neoplasia.
(Karakosta A, 2015).
• Both DNA and RNA viruses have been shown to be capable of causing cancer in humans
• DNA viruses that are capable of causing the development of human cancers:
Epstein-Barr virus,
human papilloma virus
hepatitis B virus
human herpes virus
• RNA viruses that contribute to human cancers:
Human T lymphotrophic virus type 1 and hepatitis C viruses
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6. • Close study of viruses and human cancer has led to optimism for the development of new
strategies for the prevention of the preceding infection that can lead to carcinogenesis
• The presence of viral gene products in tumor cells that require them to maintain their
unchecked proliferation also can provide important targets for directed therapies that
specifically can distinguish tumor cells from normal cells
• Targeted therapies directed against viral proteins or generate immune responses in order to
either prevent infection or kill infected cells or cancer cells hold much promise for more
effective and tolerable strategies. (Karakosta A, 2015).
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7. Statement of Problem
• It is now recognized that many cancers have an infectious etiology
• Between 5% to 20% of human cancers worldwide are virus-induced[Lopez et
al.,2007]
• Approximately 80% of virus-induced cancer cases are represented by cervical
cancer and hepatocellular carcinoma [Lopez et al .,2007]
• Virus-induced cancers represent a true African continents specificity, compared
to cancers affecting developed countries that depend mainly on hormonal and
genetic factors [Garcia et al., 2017].
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8. Justification
• The morbidity and mortality of this preventable scourge continue to remain high in developing countries like
Nigeria, where as in developed countries it continues to be on decline
• This difference in the incidence of cancers of varial origins between develops and developing countries illustrates
the huge disperity in wealth and availability of extensive screening programs
• The prevalence of cancers of viral origin in Europe and America has decrease considerably because of the
widespread use of screening procedures such as Hepatitis B, surface antigen (HBSAG) and papanicolaou (PAP)
test adopted the second half of the 20th century, this diseases, should be recognized as an important public health
problem in Nigeria and should be seen as an important cause of misery in women by introducing screening policy
and the use of available preventive measures such as Vaccination, as obtainable in developed countries (Cronje
et’al., 2014).
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9. AIM
• To Assess The Prevalence Of Viral Induced Cancers In Patients Seeking
Care In The Obstetrics And Gynecology Department Of JUTH.
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10. OBJECTIVES
 To assess the prevalence of viral induced cancers in the O&G department of
Jos University Teaching Hospital.
 To compare the management of viral induced cancers in JUTH with standard
treatment guidelines.
 To evaluate patients outcomes.
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11. METHOD
• STUDY DESIGN, AREA AND PERIOD
It is a Retrospective Cross sectional assessment of the Prevalence of Viral Induced
Cancers In Patients Seeking Care In The Obstetrics And Gynecology Department Of
JUTH, between the month of January 2021 to October,2022
• STUDY POPULATION
The study population are Cancers Patients Seeking Care In The Obstetrics And
Gynecology Department Of JUTH
• Sampling Method
Non probability sampling method was used
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12. Method
• SAMPLE SIZE
• Kish.L (1965) formula and using 16% as the percentage prevalence of Viral induced cancers as a study showed
carried out in Anambra State south-east Nigeria [obeke et al., 2016]
N = Z2P (1-P)
D2
Where N=Minimum sample size
Z=standard of normal deviation 1.96
P=Prevalence rate of the disease 16% (Obeke et al., 2016)
Q=1-P
D=Margin of error=0.05
• 𝑁 =
1.96 2𝑋0.16(1−0.16)
0.05 2
N= 206.5 ~ 207
Sample size of 207 was calculated. 10% attrition= 228
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13. METHOD
• Data was collected using a profoma
• Data collected includes:
Demographic data
Causative organism involved
Medications used
Vaccines used
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14. Results
• PREVELENCE
• Prevelence 𝑃 𝑷 =
Number of patients with Viral Induced Cancers in O&𝐺
Total number of patient that had cancer in O&𝐺
• Total number of patients that had cancer in O&𝐺 = 2680
• Number of patients with Viral Induced Cancers in O&𝐺 = 134
•
𝑃 =
134
2680
• = 0.05 (5%)
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15. VARIABLE ATTRIBUTES FREQUENCY PERCENTAGE(%)
Age (In Years)
20-25 20 14.93
26-30 22 16.42
31-35 46 34.32
36-40 22 16.42
41-45 24 17.91
Gender
Female 134 100
Marital Status
Single 26 19.40
Married 108 80.60
Educational Qualification
Primary 50 37.3
Secondary 24 17.9
Tertiary 60 44.8
Occupation
Student 52 38.8
Housewife 29 21.6
Business women 23 17.2
Civil servant 30 22.4
Religion
Christian 92 68.66
Islam 42 31.34
Table 1: Socio-Demographic Data N=134
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16. Viral induced cancer Causative Organism Frequency Percentage (%)
Nasopharyngeal carcinoma Epstein-Barr virus 22 16.42
Cervical cancer Human papillomavirus 31 23.13
Hepatocellular carcinoma Hepatitis B and C virus 60 44.78
Kaposi's sarcoma Human herpes virus 8, HIV
and AIDS
21 15.67
Table 2: Viral induced Cancer N=134
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17. Vaccines Frequency Percentage(%)
Human Papiloma Virus Vaccine 29 55.8
Hepatitis B virus vaccine 23 44.2
Table 3: VACCINES N=52
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18. Procedures Frequency Percentages(%)
Loop electrosurgical procedure 5 14.71
Suggested Surgical resection and Liver
transplant
20 58.82
Neck dissection surgery 2 5.88
Radiation Therapy 7 20.59
Table 4: Procedures conducted N=34
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19. Medication Frequency (N) Percentage(%)
Silymarin 30 37.5
Lactulose 29 36.25
Furosemide 11 13.75
Spironolactone 9 11.25
Tenofovir 10 12.5
Poor salt Albumin 32 40
Carboplatin +Docetaxel 15 18.75
Gemcitabine + Cisplatin 11 13.75
Cisplatin + 5-Fluorouracil 9 11.25
Sofosbuvir + Daclacasvir 4 5.0
Sofosbuvir + Velpatasvir 5 6.25
Tenofovir + Lamivudine + Dolutegravir 7 8.75
Table 5: Medication used
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20. Hepatocellular carcinoma Hepatitis B virus  Prevented by Vaccination
 Not treatable but managed with Tenofovir or
Lamivudine
Hepatitis C  Treatable disease with Sofosbuvir together with
Direct acting antiretroviral drugs e.g Daclatasvir,
Velpatasvir
Adjunctive treatment
Silymarin, Hepatic Phospholipids and Vitamins
Cervical cancer Human papillomavirus
 Prevented by Vaccination
 Procedure is required to remove the cell (Loop
electrosurgical procedure, Cryotherapy)
 Managed with Chemotherapy based on the stages
 Eg; Carboplatin, paclitaxel
Nasopharyngeal carcinoma  Radiation therapy
 Chemotherapy
 Neck dissection surgery
 Eg; Cisplatin, Docetaxel, 5-FU, Capecitamine
Kaposi's sarcoma Human herpes virus 8, HIV and AIDS
 Antiviral medication such as Acyclovir, Famciclovir
 HIV can be prevented by the use of PrEP (Pre-
exposure prophylaxis
Chemotherapy
eg; Doxorubicin
Table 6: STANDARD TREATMENT GUIDELINES
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21. Treatment outcome Frequency Percentage(%)
Discharged to continue management 20 15%
Deceased 114 85%
Table 7: Treatment outcome N=134
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22. Nasopharyngeal
carcinoma
N(%)
Cervical cancer
N(%)
Hepatocellular
carcinoma
N(%)
Kaposi's
sarcoma N(%)
P-value(X2)
Discharged to
continue management
12(60) 5(25) 2(10) 1(5) 0.02(45.8)
Deceased 8(7.0) 30(26.3) 62(54.4) 14(12.3)
Table 8: Relationship between types of Viral induced cancer and Treatment outcome
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23. Discussion
• The study design of this project was a retrospective assessment using non-probability
sampling method.
• Prevalence rate of 16% gotten from a previous study done in Anambra State, South-east
Nigeria by Obeke in 2016, was used to calculate sample size
• The prevalence of viral induced cancer in this study was 5% which is in contrast with a
study by Obeke et al., 2016, which recorded a prevalence of 16%
• The lower prevalence recorded in this study maybe due to increased awareness since
most of the study participants have attained tertiary level of education
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24. Discussion
• Majority of the individuals falls within the age 31-35 years. About 80.60% of the participant were married,
19.40% were single. Based on the level of education majority (44.8%) went through Tertiary school. As
compared to a work carried out by Dasen, 2013 which reveals that majority of the patients went through
secondary school and fall within the age of 30-36years
• Based on the Viral induced cancer , the most prevalent is Hepatocellular carcinoma which was as a results of
Hepatitis B and C virus. Which is well justified seeing that in the world today to a substantial number of the
Nigerians they either have Hepatitis B or C which has a detrimental effects on the liver, which causes different
kinds of liver damage owning to Ascitic liver disease, hepatic encephalopathy
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25. Discussion
• Generally those that have Cervical cancer are 31[23.1%] and are as a result of Human
papilloma virus infection. However, most of the patients also have weakened immune
systems, such as those with untreated HIV infection, and this results in fast progression of the
disease
• Some of the patients have HIV/ AIDS and while some has human herpes virus 8 which
resulted in Kaposi sarcoma 21[15.67%]
• Vaccination has been a great platform in the prevention of diseases, [Dasen, 2013]
• Of the 134 participants 52 patients were vaccinated, 29(55.8%) were given Human
Papilloma Virus Vaccine whereas 23(44.2%) were given Hepatitis B virus vaccine as a
preventive medication
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26. Discussion
• From the study carried out on the viral induced cancer, a few of the population had actually undergo some
procedure as part of the management plan for the treatment of such virus
• About 6.25% underwent Loop electrosurgical procedure which was used in the management of the cervical
cancer, 25% were Suggested Surgical resection and Liver transplant used for the Hepatocellular carcinoma,
2.5% of the study participants had Neck dissection surgery done for Nasopharyngeal carcinoma and Radiation
therapy was conducted for 8.75% of the patients in the management of Kaposi's sarcoma
• And this is in line with the procedures/ standard treatment guideline prescribed by ESMO[European society
for medical oncology].
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27. • Majority of the patient had Hepatocellular carcinoma 42.5% which resulted from Hepatitis
B and C virus, of this population 12.5% were placed on Tenofovir which was indicated to
manage the Hepatitis B
• For the Hepatitis C 5% were placed on Sofosbuvir + Daclacasvir while 6.25% were placed
on Sofosbuvir + Velpatasvir. The poor salt albumin was initiated as a results of Ascitic liver
cirrhosis which arises as a result the damage the disease. Also to a great extent Frusemide
and spironolactone was use as cornerstone of fluid management in ascites
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28. Discussion
• Some of the patients were placed on Chemotherapy, of which 18.75% were place on
Carboplatin +Docetaxel which was used in the management of Nasopharyngeal carcinoma
• Of the patient having Cervical cancer and placed on Chemotherapy 13.75% were placed on
Gemcitabine + Cisplatin, 11.25% were placed on Cisplatin + 5-Fluorouracil
• For patients having Kaposi's sarcoma, 8.75% were placed on Tenofovir + Lamivudine +
Dolutegravir due to HIV and AIDS
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29. Discussion
• The adjunctive medication used, Silymarin was used which serve as the hepato-protective
medication
• Majority of the patient 85% based on the research on viral induces cancer died afterward
only about 15% were discharged to continue management
• Based on the relationship between types of Viral induced cancer and Treatment outcome it
reveals that there was a significant relationship that exist between the treatment outcome and
the viral induced cancer, showing that more of the patient with Hepatocellular carcinoma are
deceased
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30. Limitations of the Study
 The sample size calculated was higher than the available number of folders. Thus,
a calculated sample size of 228 was done but the sample size accessible was only about 134
 Some of the patients’ folders were missing, thereby, limiting the accuracy of the study
• There were lots of incomplete and abandoned treatments due to financial constraints
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31. RECOMMENDATIONS
 The results of this study outline the need for the government to start cervical screening
programs not only at the tertiary centers but also at primary health centers to help for early
detection and management
 More awareness should be spread via the media on the preventability of some of the viral
induced cancers by vaccination
 Lifestyle modification should be encouraged
 Early vaccination of the girl child against HPV and HBV is highly encouraged
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32. Conclusion
• The percentage prevalence rate of viral induced cancer cases in the O&G unit of Jos
University Teaching Hospital (JUTH) between September, 2021 to September, 2022 was 5%
• Majority of the patients (85%) were deceased, only a few (15%) were discharged to continue
management
• The treatment pattern is in accordance with the standard treatment guidelines provided by
European Society for Medical Oncology (ESMO) and National Comprehensive Cancer
Network (NCCN).
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